HomeMy WebLinkAboutXR2022-3135 - Permit Applicationworksheet for Combo Ouilding & SOW Permit Appilcaflon
rr"I j�,,tResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
P
,widirg [_ Grading F—Drainage ' K 6jec 17�_ ech F Plum cu Yd cut I __ Cu Yd Fill I--- —
,oject Address (Not mailing address) F_ Flood Fire Liq r Landslide F_N/A Floor Suite No
ce
Jescription of Work ConstType
1 477 VZ4 L UVML Use
# S,toriesFT# Units (if Res)F_17
New/Add SF RemodelGarage/New/Addy Valuation $ bo
SF F ew/Add F Material/La
OWNER'S NAME Last
I First
Owner's Address Owner's E-mail Address
City State ZiPF7— Telephone
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
CT
City State Zip Telephone
I Mid-(�; —
ARCHITECT/DESIGNER'S NAME Last
First F L I c. N o. F7— —je-517171 7,
Architect/Designer's Address Architect/Designer's E-mail Address
CitYF_ State ZipF_ Telephone
ENGINEER'S NAME Last Via First Lic. No.
Engineer's Address
Engif"rs E-mail Address
7 1
State Zip Telephone
City Z71�q �?j
CONTRACTOR'S NAME/COMPANY F "4,-v4LVV-, Lic. No. F_ Class F_
Contractor's Address Contractor's E-mail Address
City State F Zip F— TelephoneF®
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $