HomeMy WebLinkAbout1219-2017Print Form
F- Comm'I F- Residential
Worksheet for Building Combo Permit Application w�q.
City of Newport Beach -Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
F-Building F- Grading F—Drainage
F- Elec F- Mech F- Plum cu d ut �1YRIC ISI N
Project Address (Not mailing address) OF NEWPORT BEACH
Floor Sc to No
14005 MA?Gu
Description of Work
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Use
# Stories # Units (if Res)[_
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Valuation $ L�
Material/Labor VT O�
New/Add SF Remodel SF
Garage/New/Add
OWNER'S NAME Last
DOr� First
Owner's Address
Owner's E-mail Address
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City I N�WpOO bew/yh
State Zip Telephone z 1
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APPLICANT'S NAME Last
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plicant's Aoress
J Ap licant's E-mail Address
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State I F lll///��, ��, 1 "�,1� Zip I✓I � / I., Telephon f �
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ARCHITECT/DESIGNER'S NAME Last F_ �—
Lic. No.
Architect/Designees Address
Architect/Designees E-mail Address
City I
State F__— Zip F_ Telephoned
ENGINEER'S NAME Last
1 First i ) � Lic. No.
En ineer's Address
Engineer's E-mail Arnddress
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State— Zip I— IV I—) Telephone13�
CONTRACTOR'S NAME/COMPANY
1 Lic. No.� Class
1
Contractor's Addre s
Contractor's E-mail Address
City
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State— Zip[L�= TelephonerjV.G�1-4312,1
ENERGY P/C FEE $ FIRE
P/C FEE $ PERMIT NO.
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO. 1pQAQ 610 l%
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $
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642 Baker St. Costa Meso, CA, 92626
®Swift Slip Dock & Pier Builders, Inc Phone: 1949) 631-3121
Fox: f 714) W9-0618
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EN PS 9123/I6 A ENDMENTS:
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4005 Marcus Avenue
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CITY OF EW'P1l
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