HomeMy WebLinkAboutX2012-1708 - Permit Application-;1?rinForm-(Worksheef for Building Combo Perml tion
F-1 Comm'IResid ntiae I City of Newport Beach - Building Divisio
NOTE: PLAN CHECK FEE DUE AT TIME OF SUB
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Project Address (Not m 'ling address) Floor Suite No
Description of Work
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#Stones #Units (if R�efs)j
Valuation $ •' -"�—'
Material/Labor
New/Add SF (,
Rem99del S Garage/New/Add -
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OWNER'S NAME
Last et_. First d
Owner's Address
Owner's E-mail Address
City -_G -
State Fl Zip � Telephone , -?-%% 7z�2
APPLICANT'S NAME
Last S/(% Ni b First
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Applicant's Address
Applicant's E-mail Address
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City r /
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State Zip I w Telephone
661
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ARCHITECT/DESIGNER'S NAME Last�-Ia First �FQE Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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City + State Zip Telephone
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ENGINEER'S NAME
LastFirst �G t'_I LPc.Na o
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Engineer's Address
- Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY Lic. No.�7Class (I
Contractor's Address Contractor's E-mail Address
City ---------
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ENERGY P/C FEE $
ltd -CFIRE P/C FEET$ 1 [j r)�j'a PERMIT NO.
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GRADING P/C FEE $
PLANNING P/C FEE $ / • L'S PLAN CHECK NO.
ELEC/PLUM/MECH P/C FEE $ CITY OF NL`VF()i-fi� L''LACH .PLAN CHECK FEE $
DEVELOPMENT # -.
TOTAL FEES PAID $
1s