HomeMy WebLinkAboutX2016-4019 - Permit ApplicationP:�f- P4W-fXgXj0141'l
Worksheet for Goiritlho ufloJing & Wear Permit Application o���WP°Rey
�City of Newport Beach - Building Division
I
Comm'[ rK Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
,G/PORN
fvRuilding C Grading I Drainage J-Pec l Mech Cu vd Cut Cu vd Fill
Project Address (Not mailing address) Flood r Fire Liq r Landslide F N/A Floor Suite No
F177,9_ :[_2vfoE -c
p =9 8 r�
Description of Work
_
Use Const Type
A-yo C)vfK�_ +— 20 we.�% ova-,&
10yr
# Stories #Units (if Res)'
,
Valuation$`
Material/Labor.
--__- -_
New/Add SF} Remodel SF
t� �
Gara e/New/Add
g � ��_
OWNER'S NAME Last (
First
Owner's Address ) Z 1 576(JAW�
N � � IS
Owner's E-mail Address
MA-LKes SAVAA � S� t�
- _ -
L �"Vwocs aA•fVe
City a State Zip Telephone
APPLICANT'S NAME Last .�,��
--- -
First r
n�I
Applicant's Address
^ si1�•-ram a� r ,
Applicant's E-mail Address v/
I � �N � � ����r u� �
City �`� State �L1�
Zip �C�O Telephone ��3s•-Z364-
ARCHITECT/DESIGNER'S NAME Last f Days C� First[ Lic. No. r �.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State dLt,� Zip Telephoned
ENGINEER'S NAME Last �q,� t !�� tY'(
First f L. tty�,� Lic. No.(
Engineer's Address
Engineer's E-mail Address
N- - V 1 c E #
City �%f7 ul State r 1,
Zip � � Telephoned - 164 fZic>
® _-
-
CONTRACTOR'S NAME/COMPANY Lic. No. U �C�i3 Class
Contractor's Address
Contractor's E-mail Address T ��
_,?_t�
City S - , j State � L ��
Zip Telephone I y3-358 � 7
SETBACKS REAR SETBACKS FRONT
PERMIT NO. no `I t) l�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. �- j� (,O,
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $