HomeMy WebLinkAboutX2021-3103 - Permit ApplicationL. Print Form;, Worksheet for Combo Building & Sola e2i A: 1-s- 0.)
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F, City of Newport Beach -Building Div
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NOTE: PLAN CHECK FEES DUE AT TIME OF B Vicat' nv�
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F -Building F_ Grading f—Drainage F_ Elec F,_ MechPlum Cu Yd Cut I
Cu Yd Fill
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Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq f— Landslide F_.N/A Floor Suite No
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Description of Work
Use Const Type 111
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#Stories[— # Units (if Res)[
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Valuation $
Material/Labor
New/Add SFF77-- RemodelSFF77777 Garage/New/AddF7-7
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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city State Zip[ Telephone
APPLICANT'S NAME Last S,+c First
Applicant's Address Applicant's E-mail Address
City F;� _P:X2_T_8_6,5� State Telephone
Zip F�� F_
ARCHITECT/DESIGNER'S NAME Last FirstF Lic. No.
Architect/Designer's Address Architect/Designees E-mail Address
City State r Zip Telephone[
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ENGINEER'S NAME Last FirstF_ Lic. No.F77777
Engineer's Address Engineer's E-mail Address
City -.7 State F. -Zip Telephone
CONTRACTORS NAME/COMPANY Lic. No. /0 V_O /(Class
Contractor's Address Contractor's E-mail Address
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State Zip Telephonel F7a '�7�8
6 *2 q -PERI
SETBACKS REAR SETBACKS FRONT PERMIT NO. �<zoz W3
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. P.,e v Z I 1903
USE ZONE DEVELOPMENT NO (DZO OL4q6— PLAN CHECK FEES $