HomeMy WebLinkAboutXR2022-3274 - Permit Application�_: Print Form �� WOrksheet for COI' bo UuMing & S®la(r lk"Ier itl Application
(,j/Comm'I residential City of Newport Beach - Building Division Z( % � (O �,
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(Building Grading Drainage Elec F_Mech Plum CuYdCute CuYdFill
Project Address (Nut mailing address) L- Flood F Fire F_ Liq F- Landslide F_N/A Floor Suite No
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Description of Work,90/!4!: �/CAI ,
Use/t 'ConstType
2 ANV /A1ev1A`-7ev pp�� ��� �GA� #Stories #Units (if Res)
F. g �� Mate al/Labor
New/Add SF R�uedei SF s Gara a/New/Add Z
OWNER'S NAME
First
Owner's Address —
Owner's E-mail Address
City �--�" State I—
_. Zip �— Telephone
APPLICANT'S NAME Last First Af
Applicant's Address Applicant's E-mail Address
--------
City ND State /4 Zip 92.6G,p Telephone G/re
91�;
ARCHITECT/DESIGNER'S NAME }�
Last ._.(` ld_..... - - First KALic. No. Z ZZ
Architect/Designer's Address Arch itect/Designer's E-mail Address
S ,s rc 49 A ISa i/�
-- ---- -- _ -- -- .. -- _. --
City I Zip Telephone
ENGINEER'S NAME Last First
Lic. No.
Engineer's Address Engineer's E-mail Address
city State Zip �s Telephone
CONTRACTOR'S NAME/COMPANY I J Lic. No. k Class��
Contractor's Address r Contractor's E-mail Address
_La o -, Y\(3e_,q, , C OWL,
w .. I C p �� Telephone
City State zip q ` Q
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. x Q2Z.�Z't 3
PLAN CHECK NO.
PLAN CHECK FEES $