HomeMy WebLinkAboutX2021-0139 - Permit ApplicationpKy Comm'I ❑ Residential
Worksheet for Building Combo Permit Appiication
City of Newport Beaoh -.Building Division .-
NOTE PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
DGrading []Drainage 4BBC Mach APlum Cuvdcue= Cu Yd Fla
Project Address (Not mailing address)
of Work
New/Add SF�JRemodel SF Gsrege/Nsw/Add
OWNER'S NAME Last
Owners Address -
I _3 —
city - - L��� —� stare r
APPLICANPS NAME - Last
Applicant's Address .
City
ARCHITECTfDESIGNER'S NAME Last
Archlteot /signets Address
City �M,C I State
First
Owner's E-maA Address
23p
Floor Suite No
L—J
Uea : Olt' 5�ii�w
# Stories' S Units (if ResCj
)' °a alp
—J First IyINY i I=
Appli anh E-mell Address
Zip 1 I L(5� Telsphonsr %i
1 ra 42 N& IP
Archltact/Designw's E-mail Addrsst
zip _� Telephone'– I J
ENGINEERS NAME Lest �— FirstE= - Uc N -f�
Englnser's Address
Engineer's E -mall Address
city, §tats C� Zip I TelaphonaE. __=1
CONTRACTOR'Sf4AME/CQMPNff _ Uc.No. Cless�
Contractor's Addrees Contreclors E-rnall Address
I
City State �� Zip Tslaplrone�—� .
ENERGY P/C FEE $
GRADING PIC FEE $
FIRE PIC FEE S
PLANNING PIC FEE $
PI72Mrr NO. -' !
PLAN CHECK N0.
ELECIPLUIvt/MECH P/C FEE $ _ PLAN CHECK FEE $