HomeMy WebLinkAboutX2021-3127 - Permit ApplicationI :Prinf Fnrm`. -I 1A/nrlc hnat fnr (tnmhn Rnilrlinn X Cnhr Paw if A nnlir�finn_ i
Comm'IResidential City of Newport Beach - Building Divis
NOTE: PLAN CHECK FEES DUE AT TIME OF S,'
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F Building F_Grading rainage lec ilech Plum crYd�uc CavdF(n ''
Project Address (Not mailing address) C Flood Fire [- Liq Lah�ghdeN/Il< `loop < Suite No
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Description of Work
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# Stories # Aots f Res) n
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Va ati$
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New/Add SF� Remodel SF Garage/New/Add
terial/abor(� C/
OWNER'S NAME--
Last _ Cj1.- i ..----.___..__' First C -i L°, 7
Owner's Address Owner's E-mail Address
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City n %� _ - State I C Zip Telephone r%� L_ X13..-16
APPLICANT'S NAME Last First
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A licanfs Address Applicants ' E-mail Address
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City �I� State Zip <� n Telephone ^� 3 Al�2
ARCHITECT/DESIGNER'S NAME Last First
—-v }-/�- f ^ ' Lic. No.
Architect/Designer's Address Architect/Designer's E-mail ss
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City F_2CS,cJ� State Zip q4 �g Telephone 5( 17 2%_��-��j�
ENGINEER'S NAME Last First F Lic. No . F777
Engineer's Address Engineer's E-mail Address
City State F_ Zip Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State F Zip I Telephone
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $