HomeMy WebLinkAbout2571-2017 - Permit ApplicationPrint F'onn 1r�%°Cc�G�O�� fOfr (;orflb0 ,83uflffing U3 Sdar permit Application
I� Comm'I Residential City of Newport Beach - Building Division t
DUE AT TIME OF SUBMITTAL
r6uilding [7 Grading F-Drainage (— ElecAN CHEFEES
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F PIUm Cu Yd Cut Cu YdFill
Project Address (Not Maiilling address) Ili Flood f—, Fire f-; Liq r'°i Landslide f7N/A Floor
3 �, _ I
Suite No
Description of Work _.
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New/Add SF
Use Const Type
# Stories # Units (if Res)-
Valuation $
Material/Labor
OWNER'S NAME - � ----- ,
Last �PFirst F
Owner's Address
_ - Owner's E-mail Address
-- - -- -_
City C' _Y�\�i.( 1. C,
v -- - --I State Telephone I ` ,
Remodel SF
F Garage/New/Add r
APPLICANT'S NAME -
Last /Q
-`' "�- --- First
Applicant's Address
^� Applicant's E-mail Address
- 4v\ _a feT
-
City 1�
-- -
State - ._. Zip 4 ) Telephone GJ - ✓
--
ARCHITECT/DESIGNER'S NAME
Last �.__._..___�-._..�.. First �r..
Lic. No, 1
Architect/Designer's Address Architect/Designer's E-mail-Address
State -- --- -� - ---- -
City Zip Telephone
ENGINEER'S NAME
ast First Lic. No i
Engineer's Address Engineer's E-mail Address
city
StateF_ Zip Telephone
CONTRACTOR'S NAME/COMPANY
Contractor's Address
-�
Lic. No. � 1_�-21' �i v�-�i1,.�1.✓�' � Class;
Contractor's E-mail Address
City State I Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $