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Home My WebLink AboutXR2023-0322 - Permit ApplicationPrint Form Worksheet for Combo ufiffing Sol r Pe •remit Application COJUSM),�, f�.omm'I (residential City of Newport Beach -Building Division K � M.2 - O'j71 NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL (Building ( Grading FDrainage [_ Elec [_ Mech Plum Cu Yd CutF_ Cu Yd Fill F_ Project Address (Not rr roiling address) [7 Flood F_ Fire f_" Liq F_ Landslide F_N/A Floor Suite No nt/s sta _�._ - --... _ -............. - - f - Description of Work Fv/- UseUConstType ' fG� SGlL ` AS # Stories # Units (if Res) 7 Valuation $ �n da New/Add SF�— ��sq�od 'IVf Garage/New/Add �— Material/Labor �(�1 OWNER'S NAME Last l�`�T / 12- C� First Owner's Address Owner's E-mail Address - - ..._ _...-. ---------- ---.. _ ...._.._ ...... City Zip �— I elephone[ APPLICANT'S NAME Last A x First ,t Applicant's Address Applicant's E-mail Address �._v/Z- City %:?A4,0.OA SG�� State7�7 Zip Z- Tele hone ARCHITECT/DESIGNER'S NAME Last A L'� w t �Z" /(// .. First /� _ Lic. N ---- --- Architect/Designer's Address Arch itect/Designer's E-mai Address -- C it ''�� _... y -- — " staMs- Zip TelephoneF777 ENGINEER'S NAME Last First Lic. No. Engineer's Address Engineer's E-mail Address ....... _ _ $ city State �� Zip �— Telephone CONTRACTOR'S NAME/COMPANY .Z (Z. (� � Lic. No. ��5 Class Contractor's Address q(_o�C"ontractor's E-mail Address City State _ Zip Telephone � � L/ -/? / ©CL SETBACKS REAR SETBACKS LEFT USE ZONE SETBACKS FRONT SETBACKS RIGHT DEVELOPMENT NO PERMIT NO. PLAN CHECK N0. PLAN CHECK FEES $