HomeMy WebLinkAboutX2019-2065 - Permit Application� � 9-2019 X2019- �06�
Mr shE;et for Building Combo Permit Application
r City of Newport Beach - Building Division
Co nm'I ❑ Resid tial NOT AN CHECK FEE AT TIME OF SUBMITTAL
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(Building [Gra 'ng ]E)Mhagu,"Pe'ss)
PrdjeCt Address (Not r6' affing �, Floor Suite No
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Descr'iption of Work
Use
# Stories #, Un€ts (I Res)
Valuatil
Material/Lonabor[j,
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New/Add SFRemodel SF 7> Garage/New/Add ��
OWNER'S NAME Last /�- Flrst
Owner's Address Own is E-mail Address
city �- -_ State — Zip Telephone
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APPLICANT'S NANf6ELast I I Nv l First{
Applicicanttt''s Address _ Applicants E-mail Address
City ��j State � Zip Telepho/ne[ -
ARCHrTECTI'DESEGNER'S NAMELast 4 j � � First � Llc. No. Ci
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Architect/Designer's Address Architect/Deslgner`s E-mail Addrese
City EMWYW ��Ld State i'< ZipTelephone 1�17J'
ENGINEER'S NAME Last [ _ First � � Llc. No.��
Engineer's Address Engineer's E -mall Address -
i
City _ State Zip = Telephone
DONTRACTQR'S1UAME/GOMPANY _fi(� / �/p Lic. No. 6 iSi 7 b Class
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Contractor's Address Contractors E-mail Address
City (,OS{-^ mlr s `• _.� state ZT7 Zip `i Zb L Telephone '7 1 1 '2'j1"-1143'0
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ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING PIC FEE $PLAN CHECK NO.
-- PLANNING P/C FEE $
EI-ECIPLUM/MECH P/C FEE $.
D EVELOPMENT #
PLAN CHECK FEE$
TOTAL FEES PAID $