HomeMy WebLinkAboutXR2022-2621 - Permit ApplicationL Print Form s� Worksheet for Combo Buflding & 8eiar Peymi r A;PPlicinruon ctlillci
Cit pof New ort Beach - Buildin Division Opp ��j�-,eoik S�(� Comm] jW Residential NOTE: PLAN CHECK FEES DUE ATTImp nFSiiRnni`Toi V'19•,_. r-,f a
F-Building Grading F-Drainage r Elec Mech Plum CuYdCut l CuYdFill
Project Address (Not mailing address) 1- Flood Fire F_ Liq f- Landslide F_N/A Floor Suite No
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Description of Work W4.3 60T AWV fiU'J'^C6A J
� Const Type
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t # Stories # Units (if Res)s
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Q C C D Valuation $
New/Add SF Remodel SF Garage/New/Adds-- Material/Labor
OWNER'S NAME Last M Q First �l .2..j`�
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Owner's Address Owner's E-mail Address
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city State e Zip �— Telephone '71'3
APPLICANT'S NAME Last First
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Applicant's Address Applicant's E-mail Ad ress
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Zip
Telephone f
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ARCHITECT/DESIGNER'S NAME Last, first C Lic. No.
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Architect/Designer's Address Architect/Designer's E-mail Address
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Cit Lq
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P �� Telephone q �[. 1�
ENGINEER'S NAME Last First Lic. No.�
Engineer's Address Engineer's E-mail Address
City State Zip Telephone
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CONTRACTOR'S NAME/COMPANY i 1 �[ /_ -_, , l ic. No. LQ� 0� 3IClass�
Contractor's Address Contractor's E-mail Address
City � �j-1 State Zip �2�0� Telephone d �({
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. eczz /�n
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USE ZONE DEVELOPMENT NO /�'E�l, I T PLAN CHECK FEES $
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