HomeMy WebLinkAboutX2020-1886 - Permit Application (3)4�M,_O_ NIQ
_Print Form_]orksheet for Combo Building & Soar Permit Application Poll
F_ Comm'I Residential Cityof Newport Beach - Building U
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_Building F_ Grading
F—Drainage F Elec j Mech "Plum Cu Yd Cut Cu Yd Fill F
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Project Address (Not mailing address) F_ Flood F Fire r` Liq Landslide F_N/A Floor Suite No
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Description of Work
Use Const Type F_
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# Stories[ # Units (if Re
Valuation $ 4�r
Material/Lab c•, , c,.,1
New/Add SF 5F Remodel SF
Garage/New/Add F
OWNER'S NAME
Last j�� %
First
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Owner's Address
Owner's E-mail Address
City , ,
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State
F4, Zip i Telephone (' 3 �
APPLICANT'S NAME
Last
Q��'�
� First
Applicant's Address
Applicant's E-mail Address
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City ,j k
S State -4,
Zip �% � Telephone 7/ 3 r
ARCHITECT/DESIGNER'S NAME
Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State r
Zip Telephonef
ENGINEER'S NAME
Last
First Lic. No.1
Engineer's Address
Engineer's E-mail Address
City [
State r_
Zip _ Telephones
CONTRACTOR'S NAME/COMPANY
Lic. NoT� Class[
Contractor's Address
Contractor's E-mail Address
City
State
Zip TelephoneF
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $
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