HomeMy WebLinkAboutX2016-3271 - Permit ApplicationI Print Form
Comm'I ( Residential
X 2-01 LP -3 211
Worksheet for Building Combo Permit Application
City of Newport Beach - Building Division Wn 19
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
F-BuildingF_ Grading F -Drainage r-Elec r-Mech
i-` Plum Cu Yd Cut Cu Yd Fal
Project Address (Not mailing address}
Floor Suite No
�
211 04 Mira Mar Drive
F_ [-
Description of Work
Use
Replace 1 retro -fit window and 1 patio door. No size changes.
It StoriesF #Units (if Res)
i
Valuation $ F_
New/Add SFI T Remodel SFF_ Garage/New/Add 1___ Material/Laborl 4014..00
OWNER'SNAME Last Marcias
First Fred
Owner's Address
Owner's E-mail Address
2104 Mira Mar Drive
r- __
city 1 Newport Beach state CA
zip 92660 Telephone_
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
32158 Camino Capistrano, Suite A-444
city San Juan Capistrano state I CA
Zip 92675 Telephone(949) 207-3468
ARCHITECT/DESIGNER'S NAME Last
First 1_ Lic. No.
Architect/Designer's Address
Architect/Designers E-mail Address
City F_ State F_
i
Zip 3 Telephone
ENGINEER'S NAME Last F—
u First Lic No.F_
Engineer's Address
Engineers E-mail Address
City State
Zip Telephone�
CONTRACTOR'S NAME/COMPANY H D At -Home Services Inc. DBA Lic. No. 836021 Class IB�_
BL #BT30026741 he Home Depot At -Home
Services C39, C-2,
C17
Contractor's Address
Contractor's E-mail Address
x13250 Gregg St. Suite A2
City [Poway state CA
zip 92064� Telephone 858-859-4143
ENERGY PIC FEES FIRE PIC FEE $
PERMIT NO.
GRADING PIC FEE $ PLANNING P/C FEE $
PLAN CHECK NO.
ELECIPLUM/MECH PIC FEES
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $
D-1