HomeMy WebLinkAboutX2020-2987 - Permit Application' 'eriht"Form I Worksheet for Combo'Biiilding & Shcdr'Per`m'it /p�p�lication "oFW°� '
F_ Comm'] Residential City of Newport Beach - Building Division // l� o
NOTE; PLAN CHECK FEES DUE AT TIME OF SUB I A as
Building FGrading F -Drainage I-Elec rMech F -Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood F- Fire F_ Liq F Landslide Floor Suite No
' V SK I oe, Lt Y'ck
Description of Work
Use /. ✓ Const Type .
# Stories # Units (if Res)
�� I�
Add ku 4" -1b�/f� "j " b '
" Ov
f"��'' r J
Valuation$ 3�1.6TV
Material /Labor 7 (( LLl v
New/Add SF Remodel SF Garage/New/Add
�"`�
OWNER'S NAME Last i t-vy( exo First 9yell
Owner's Address Owner's E-mail Address
M2ZG ifop�{r`l�i".z C( I-vr.0 _
—
City lvr _ dl State (/)OF --
citys Zip —' Telephoner
Last �mW First Cn
Applicant's Address Applicant's E-mail Address
c�a�tQ 12 (. e o49-
�v�ev
d
City eift�T State �� Zip 49";2�f Telephone 4f f4. 2910, 71V
ARCHITECT/DESIGNER'S NAME Last �/Jb� First w`j�_ Lic. INo.
Architect/Designer's AddressArchitect/Designer's E-mail Address
,'/n
�w eS %[�au.�
City State F Zip F Telephone
ENGINEER'SNAME Last First ��l(� Lic. No. (2 b
Engineer's Address Engineer's E-mail Address
�9 4y.( e4z p/c'le _ZSD svQeKbt%5hcy/o
City Tr(/iAe State _ C: Zip 9,9/d04Telephone -W-•� * 096�
CONTRACTOR'S NAME/COMPANY '`'R a� /t % 6� ic� Nb. �� lass[
Vv P/ I
Contractor's Address Co tractors E- ai Address
S U1_o �0N.�es �nan �r5� an C
City rWCa� Z I r \ Zip Telephone �-1 7%
SETBACKS REAR SETBACKS FRONT 2C7 PERMITNO.
PLAN CHECK NO.
SETBACKS LEFT SETBACKS RIGHT ,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $