HomeMy WebLinkAboutX2020-0556 - Permit ApplicationPrint Form j Worksheet for Gornbo ui0dng & S o kw Permit Application
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1�orilm'1 f Resider City of Newport Beach -Building Division %� W
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL qb
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F_ Buil ng j` Grading F—Drainage [_ Elec Mech F— Plum Cu Yd Cut F(`��� Cu Yd Fill
Project Address (Not mailing address) F_ Flood F_ Fire f— Liq j` Landslide J-N/A Floor Suite No
Description of Work
Use Const Type
# Stories[ # Units (if Res)
Valuation $
Material/Labor
New/Add SF �__......�. Remodel SF
Garage/New/Addy
OWNER'S NAME Last F
First
Owner's Address
Owner's E-mail Address
City State
Zip [_ _ Telephone
APPLICANT'S NAME Last
_ First
Applicant's Address
Applicant's E-mail Address
City State
Zip � Telephoned
1 ARCHITECT/DESIGNER'S NAME Last r�l `-�'!✓
First Lic. No.
i rchitect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip I TelephoneF.��._ y•�
ENGINEER'S NAME Last
First I� Lic. No.1�
Engineer's Address
Engineer's E-mail Address
City State F
Zip Telephonel
CONTRACTOR'S NAME/COMPANY P;,/� Y�e / r `rn hme6 Lic. No. �q�� Class
Contractor's Address
Contractor's E-mail Address
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JU 0w i Yw e MCA((. cQ Vw
City iQ Of Q��� \ I State C
Zip c? Telephone 64q.
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBAC S LEFT' SETBACKS RIGHT
PLAN CHECK NO.
USE ZO E DEVELOPMENT NO
PLAN CHECK FEES $