HomeMy WebLinkAboutXR2022-3274 - Permit Application (4)'\Worksheet for Combo Hufflfflng, & So ar Permit AppNcaidon
r1<omm'I Vesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SURM ITTAI Yk J
TBuilding Y�ing f—_Drainage f— Elec F_ Mech plum Cu Yd Cut
F Cu Yd Fill F
Project Address (Not mailing address) r— Flood F_ Fire f7 Liq F_ Landslide F_N/A Floor Suite No
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.... .........
Description of Work i-er e_1-A1CX-t-112
f 112-
UseConst Type
_�7 x-
-
# Stories137 # Units (if Res)77
7V-.1-;-A1-7 0 AJ
New/Add SF Remodel Garage/New/Add
. ......
Valuation $ 0
Material/Labor X ar"
OWNER'S NAME Last First
------ ----- .....
.... ..... . ....... ---- ---
Owner's Address Owner's E-mail Addr
1,
. .. - - _ _._ ... . ..... . . ........ .
City State Zip �— Telephone
APPLICANT'S NAME Last —T-&-v,4,5z First
Applicant's Address Applicant's E-mail Address
A 6,4 LOn1 A/C C 1014f
City 1��L_ArkD State [�� Zip Telephonel
ARCHITECT/DESIGNER'S NAME Last AAA,)1e1Z_1 First 24FX)D Lic No.
Architect/Designer's Address Arch itect/Designer's E-mail Address
.............
City State Zip T e le p hone
ENGINEER'S NAME Last First F_ Lic. No. r77777
Engineer's Address Engineer's E-mail Address
. .... ... ..
City State f Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State F Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 'JC,2,#VJ :,:� IGO
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $