HomeMy WebLinkAboutX2019-1798 - Permit Applicationx"LO lQ I794��/�l�
Print Form Worksheet for Building Combo P mit Application
F Comm'I VFLadential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL c ^"
(✓Building r Grading F -Drainage rVBec r- Mach F- Plum avdataYdFill F_
Project Address (Not mailing address)
Floor Suite No
(o 17 Vista.. Bona+a, Newpoe 'B&U',N
CA 126(00 F_ �—
Description of Work
Use
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See t P, Scope.
plants
#8ories�/ #Units(it Fb4 3',
I f-P7LN�/� B19'flf ODd�S`. Z,
Valuation$
Material/Labor
New/Add SFr— Fbmodel SF See S W e,
Garage/New/Add F
lfida .S
oWNERSNAME Last 13IZOoICs
First a0U9 jLtS
Owner's Address
Owner's E-mail Address
3 144al +4-o2d `.DP-iVe
Mg. beooks @ owfl nod , cowl
City New of -t Bk State (, A
I p eacZiP q26(v0 ', Telephone yok- �0 - 3578
APPLICANTSNAME Last sp-OOkS
First DoR3las
Applicant's Address
Applicant's E-mail Address
3q qa -(:Ced 'l�we.
m9w brooks@ ow look, cowl
City I N"Op& Be.cLal -- State CA
Zip gZ3w579
ARCHITECT/DESIGNERS NAME Last �— First Fr '
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State F_—
Zip F_ TelephoneF_
ENGINEEIRSNAME Last
First—, Lic.No.F_
Engineer's Address
Engineer's E-mail Address
City [_ State F___
Zip F__ TelephoneF—
CONTRACTORSNAM&COMPANY
Lic.No. F_— aassF_
Contractors Address
Contractor's E-mail Address
City State
Zip F— i Telephone—,
ENERGY P/C FEE $ RREP/CFEE$
PERMIT NO.
GRADING P/C FEE $PLANNING P/C FEE $
PLAN CHECK N . Z
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $