HomeMy WebLinkAboutM2017-0033 - Permit ApplicationPrint Form:
[X— Comm I F— Residential
Worksheet for Building Combo Permit Application ON
City of Newport Beach - Building Division mw 1, •NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
FX_.Bullding F_Grading(—Drainage F,Elec F—Mech
IIJIVINON
rPlum Cuvdcu Cu Yd Fill
ITYOF NEWP RT BEACH
Project Address Not mailing address
1 � 9 )
F or Suitq No
5 Collins Island
oZ1
Description of Work
Use
ReinforteSbepaustingseawalLhycutitjziRg GroutedTia-Racks#Stories
# Units (if Res)F
Valuation$
F0000
Material/Labo
New/Add SFI— Remodel SF� Garage/New/Add
OWNER'S NAME Last `Thabit
First Cory
Owner's Address
Owner's E-mail Address
5 Collins Island
Cit Beach State CA
Y [Newport
Zip 92662 Telephone
APPLICANT'S NAME Last Petrov
First Plamen
Applicant's Address
Applicant's E-mail Address
23 ORCHARD, SUITE 250
P.PETROV@WSASE.COM
City LAKE FOREST State CA
Zi 92630 Telephone Fq49-206-9929
ARCHITECT/DESIGNER'S NAME Last
First F-- Lic. No.
Architect/Designees Address
Architect/Designees E-mail Address
City �— _. State —.
—
Zip 7 Telephone
ENGINEER'S NAME Last JAFARI First MASOUD Lic No. 53812
Engineer's Address
Engineer's E-mail Address
23 ORCHARD, SUITE 250
City LAKE FOREST State CA
Zip 92630 Telephone 949-206-9929
CONTRACTOR'S NAME/COMPANY n Lic. No. Class
Contractor's Address J Cu'i't'2Yso�. c �
ontrmail Address
165 Irl.brc.tD P47-4 12+4
R eyo@�x�rrsohcNsfow,�(o�s..�oh.
City N-&Jeor �- 'Be4Ck State 15i
Zip 12GG0 Telephone �Z.
ENERGY P/C FEE $ FIRE P/C FEE $
PERMIT NO. MQo 11— O_�
GRADING P/C FEE $ PLANNING P/C FEE $
PLAN CHECK NO.
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
25t - Dr TOTAL FEES PAID $
DEVELOPMENT #