HomeMy WebLinkAboutX2019-3661 - Permit ApplicationPrint Form-1 Vi!®rkshoot for Combo Building fl, Soda h° Permit Ap
f_ Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �(
wilding F Grading
f—Drainage X,Elec [_Mech [_Plum CuYdCut
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'roject Address (Not mailing address) F_ Flood [_ Fire F Liq [_ Landslide
C, ,3G61
Cu Yd Fill
f N/A Floor Suite No
Description of Work
Use Const Type
# Stories # Units (if Res)[
New/Add SF Remodel SF Garage/New/Add •---� -�-� , e/New/Add �-., Valuation O
g Material/Labor
OWNER'S NAME Last
Owner's Address
i I Gy��'T�Nd017
City r� , �►� State
APPLICANT'S NAME Last I w oOp
Applicant's Address
First
Owner's E-mail Address
Zip j _9_&e0 telephone _ _ ___
Firstl�••rl
Applicant's E-mail Address
City State l%/a Zip j Telephone" 00) 3149.7
ARCHITECT/DESIGNER'S NAME Last ��_j Vjd4 W—T First Lic. No. '?jZ �J►�j�►•
Architect/Designer's Address Arch itect/Designer's E-mail Address
4ol---Qlyb1L. I %04A.PJ@GJW41AI.r4VT
City State !/a Zip �Tj(Oi Telephone'�7r_� T/7*s
ENGINEER'S NAME Last First t yam• Lic. No.1 �1
Engineer's Address Engineer's E-mail Address
City V, �. State Fo Zip 61Z4Pj;F) Telephone41 1 07,15pk
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address Contractor's E-mail Address
City
SETBACKS REAR
SETBACKS LEFT
USE ZONE
State F Zip Telephoned
SETBACKS FRONT PERMIT NO. 1 <W_k
SETBACKS RIGHT PLAN CHECK NO.
DEVELOPMENT NO
PLAN CHECK FEES $