HomeMy WebLinkAboutX2015-1810 - Permit ApplicationW®rrksheet for Combo BuHdluolar Permit Application �9
Comm'I ( Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
f -Building r Grading ]-,Drainage -0-Eiec pcl �lum CuYdCut l C.YdFill
IPlr®pect AddrrGss (Not rm milli Dgt addiress) r-i Flood j—i Fire . i Liq f—, Landslide �'N/A Floor suite No
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Use L l Const Type
#Stories #Units (ifRes)7
Valuation $ I ��^���
Material/Labor l C,
OWNER'S NAME Last First
Owner's Address
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Citypl J�O Y._ J�, rn �_ State
APPLICANT'S NAME Last I I' p g f e r-o
Applicant's Address
City State �-
Owner's E-mail Address
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Zip Z 66;3 Telephone
First
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Applicant's E-mail Address
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Zip za J Telephone vvzn2_400
ARCHITECT/DESIGNER'S NAME Last - _ I First�� I J Lic. No. c
Architect/Designer's Address
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City.IV:
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Architect/Designer's E-mail Address
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Zip -2- Telephone qLrJ_�f��__,C
ENGINEER'S NAME Last First Lic. o. �(
Engineer's Address
City - _ - _ J State F®—I
Engineer's E-mail Address
Zip r�j Telephoned
0P6el�r�-�. I Lic No. Class
Contractor's Address
City C n-9 r6 4L e State
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
Zip ]_ Telephone Z(Y
PERMIT NO.
PLAN CHECK N0. L_ {. u, 1e.�
PLAN CHECK FEES $