HomeMy WebLinkAboutX2021-0639 - Permit Application- , tw, oul,,L,v ounaln & sour Permit 'p lication
Comm'I r Residential City of Newport Beach - Building Division g
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTA
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Project Address (Not mailing address) r Flood r Fire [_ Liq r Landslide F_N/A Floor Suite No
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of Work
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New/Add SF Remodel SF� g
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Use Const Type I v - t5
# Stories[ # Units (if Res)s
Valuation $
Material/Labor F, U C,
OWNER'S NAME—
Last _Hh... First Mi
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last
14�eKai^ First Kt j
ice
Applicant's Address
Applicant's E-mail Address
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City NCWP, Z 4�, r� State F 4 Zip �/2�(00 Tele hone
ARCHITECT/DESIGNER'S NAME
Last CO{Q-'i"�S FirstLic. No.
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ArchitectlDesigner's Address Architect/Designer's E-mail Address
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ENGINEER'S NAME Last
First Lic. No.
Engineer's Address Engineer's E-mail Address I • D15
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City Bvl,-na paf2ir_ State
C4 Zip iO4921 Telephonee"]1i7521—bS�y
CONTRACTOR'S NAME/COMPANY
Class
Co/ntractors Address Contractor's E-maild
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City �G /�y2c [/� State L Zip Z z� ] Telephone c - /
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SETBACKS REAR
SETBACKS LEFT
USEZONE
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.zA_.Q
PLAN CHECK NO.-�
DEVELOPMENT NO Q 241-1.0 �QA PLAN CHECK FEES