HomeMy WebLinkAboutPC2022-2654 - Permit ApplicationLP_rint Form .� Ifflorks-hoet for Gcc�lr bo Building & Solar pueeJ-jt Application ��gWPpRT
"
Cit of New ort Beach - Buildin Division Comm I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
CClF00.�P
F—Building Grading f—Drainage F_ Elec F_ Mech Plum Cu YdCut� Cu Yd Fill
Project Address (Not maHing address) f- Flood f -" Fire (_ Liq [_ Landslide F_N/A Floor
Suite NoF_
_( . ... ...... K� P) F
1.
Description of Work f Use F_ Const Type
# StoriesF # Units (if Res)
—F
New/Add SF Remodel SF� Garage/New/Add F__ Valuation $ Material/Labor
OWNER'S NAME Last First �J
Owner's Address Owner's E-mail Address
City State F_ Zip Telephone
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State Zip 3 Telephone ��`9 �Z,� '77J)
ARCHITECT/DESIGNER'S NAME
Last n Lin
First �t- Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
F_
City State Zip T e lep hone
ENGINEER'S NAME Last First
Lic. No.
Engineer's Address Engineer's E-mail Address
City State F— Zip �— Telephone_
CONTRACTOR'S NAME/COMPANY
Lic. No, _ .........Class!
Cont actor's Address Contractor's E-mail Address
City State Zip Telephone
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $