HomeMy WebLinkAboutXR2022-2801 - Permit ApplicationPrint -Form Fr
_ _ Worksheet for Combo Building &Sour Permit Application "
Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
70uilding r Grading I —Drainage 'cr Elec
Project Address (Not
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FMech Plum CuvdCut I CuYdFill
F7 Flood r Fire r Liq F_ Landslide FN/A Floor
Suite No
New/Add SF r `y Remodel SF 1 S�/ C Garage/New/Add �,�
Use 5 R ConstType
# Stories # Units (if Res)F
Valuation $ F!�o
Material/Labor
OWNER'S NAME Last '
First ]' ^
Owner's Address -
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Owner's E-mail Address
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City State
Zip �— Telephone
APPLICANT'S NAME
Last 171 _1/ 0 First
Applicant's Address
Applicant's E-mail Address
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City �i/� State �_ C' /
__ Zip j am( TelphoneFa N� _
ARCHITECT/DESIGNER'S NAME Last
First !�h� Lic. No.
Architect/Designer's Address Architect/DesignberU's/E-imbail Address
17
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City !V� State Zi �,� ��,j�/;� � - � -_
- p TelephoneTTW § Tfl)
ENGINEER'S NAME Last>I��/_ J) First I (/
Y`J`h ylliilC� Lic. No.
Engineer's Address Engineer's E-mail Address
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City fYllf'V l'�� - State /� ZiP F%% Telephone *'
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CONTRACTOR'SNAME/COMPANY I rv
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Contractor's Address
City ' -116+ /JITI5� State C
Lic. No. Class
Contractor's E-mail Address
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ZIP i ��'� Telephone �,67;
SETBACKS REAR SETBACKS FRONT I Ir
SETBACKS LEFT SETBACKS RIGHT T
PERMIT NO.
PLAN CHECK NO
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $