HomeMy WebLinkAboutX2015-2206 - Permit Application (3), _oI5-a_ 0G
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Comm'I ) Residential City of Newport Beach - Building Division l ^ I
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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G'�°®'ect Address (Not mailing �d¢Brrs� f v Flood Fire Li -
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_ Floor Suite No
Description of Work i f jj
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# StoriesT # Units if Res F
- � Valuation $
New/Add SF I Remodel SF Rlarage/New/Add Material/Labor
OWNER'S NAME Last F9' t ka_ I � First776.J �
Owner's Address Owner's E-mail Address
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City LW�� / State �/ �C - --- Zrp2� Telephone 3/ -
APPLICANT'S NAME Last I First �•)rah / ��',�
Applicant's Address Applicant's E-mail Address
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City �` I State Zi Telephone
ARCHITECT/DESIGNER'S NAME r�— -
Last �'� a �"� First U c.o.
Architect/Designer's Address Architect/Designer's E-mail Address
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Cit./ I (�' ffa State Zip -�b Telephone
ENGINEER'S NAME Last A� C�3
,Vt a� I I First C - �oe i Lic. No.�- -
Engineer's Address Engineer's E-mail Address
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Clay' 1 ecc, Zip Telephone
City - -- ----- -I StateI A-_ __I p l �7 �� p / S 1 2 ?v to TI 1
CONTRACTOR'S NAME/COMPANY P I t Lic. No. 56ZZ (j 7 Class'
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Contractor's Address Contractor's E-mail Address
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State Zip WT 70 -. I Telephone
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. A") L ) .__1,
PLAN CHECK NO. xI /I`_)(A
PLAN CHECK FEES $