HomeMy WebLinkAboutF2019-0671 - Permit ApplicationPrint Form Woist for Combo Building olar Permit Application
City of Newport Beach - u Sion
Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIM ft-9JINAITTAL
rBuild! ng F_Grading Drainage rElec VIMech F_ Plum CuvdCut CuvdFill
Project Address (Not mailing address) F Flood r Fir _ F Landslide I -N/A � - Suite No
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Description of Work
Use I ConstType
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i ►�tSrAt L FIRE SPR 11Ji�L cC2 S STEM
# StoriesF;5— # Units (if Res)s
Valuation $
Material/Labor i3r01�
New/AddlSF1 RemodelSFl
Garage/New/Adds—
OWNER`5NAME Last
First
Owner's Address
Owner's E-mail Address
U
City ir Wa j �
State F
Zip EkfikTelephone
APPLICA 'SNAME Last
I�pQt First
Applicant's Address
Applicant's E-mail Address
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P.[ZEtt1r. pc�C3LES e W S
City Lq Owocc�>
State I � Zip �O 1-Z Telephone I SCP7_-7_111 O%Zv
ARCHITECT/DESIGNER'S NAME
Last First F_ Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State � Zip F— TelephoneF_
ENGINEER'S NAME Last
— First F Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City
State �— Zip-- Telephoned
CONTRACTOR'S NAME/COMPANY
V IFS STCTI� FItzE oTEC�tOhl Lic. No. yN3fjcl Class' ^
Contractor's Address
Contractor's E-mail Address
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City �fk1 W (>U l�
State CA Zip IAv"j t2 Telephone S(61-- Z77c( . 0-7-1 CD
REAR
SETBACKS FRON UJ PERMIT NO.L' �V1°�I
KS LEFT
OSE
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SETBACKS RIG �" f�LAN CHECK NO.IrNE
DEVELOPMENT NO ��- PLAN CHECK FEES $