HomeMy WebLinkAboutXR2022-3004 - Permit ApplicationL P-rint Forrn_j Worksheet for Combo SuUl6ng & Sok' r Permit Ajppflcation
F_ Comm'I F_ Residential City of Newport Beach - Building Division X9021-30W NOTE: PLAN CHECK FEES DUE AT TIME OF SUB
F—Building F_ Grading f—Drainage F_ Elec f— Mech plum Cu Yd Cut F_ Cu Yd Fill
F(r(Dj8-Ct,AddTL-SS (Nc)t malflng aCjdTzSS) f— Flood Fire Liq f— Landslide F_N/A
Floor Suite No
.. ....... .
Description of Work
New/Add SF I . . ..... Remodel SFF77777Garage/New/AddF_
OWNER'S NAME Last
Use F Const Type F-7
StoriesF # Units (if Res)F_
Valuat
io
Materialta
Owner's Address Owner's E-mail Address
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city State Telephone[
F Zip
APPLICANT'S NAME Last 11
Applicant's Address
City
. ......... State F
ARCHITECT/DESIGNER'S NAME
A k;+ 4/M I
;
First I
............. . . .... .... . ...... .. ..... .. ... ........ .. ... ..
Applicant's E-mail Address
I's
Zip Telephone
Last First F Lic. No.
M, co
gner s Address Architect/Designer's E-mail Address
.. ........ F . ....
City . ....... . ..... .......... ........ .. . ... . .............. . . .. State Zip Telephone
ENGINEER'S NAME Last First
Lic. No.
Engineer's Address
1. 1-
.... ... .. . . .... . . - ...... .......
City State
. ...... ...
Engineer's E-mail Address
.. .. ..... ..... . . . ............ . ..... -------- ------
Zip Telephone F777 7
CONTRACTOR'S NAME/COMPANY 116C.*_TZA�) Class 71. Lic. No.FA
Contractor's Address
City State
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
Contractor's E-mail Address
ZIP Telephone 7 (1A)L (
PERMIT NO, Xle0z�700 —g®4_24-1
PLAN CHECK NO. ��00 ?0,Z4
DEVELOPMENT NO CHECK FEES $