HomeMy WebLinkAboutX2010-2078 - Permit ApplicationI1o51-2010 A1-ems as- D,o
Worksheet for Building Combo Permit Application
Print Form City of Newport Beach - Building Department
Please print 3 copies
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1. Project Address (Not mailing address)
Tenant Name(if Applicable)
2. Description of Work
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Exlg Building SF Derto Building SF
Extg Gar sf
Demo Garage sf
f' New fl Add FT, Alter 1—Demo
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Add/Reconstruct Bldg SF
Add/Reconstruct Garage sf
TOTAL BLDG SF
TOTAL GARAGE SF
Floor Suite No
# Units (if Residential)
Use I
Valuation $
# Stories
Cu Yd Cut
Cu Yd Fill
Check Appropriate Box for _Applicant
3. Owner's Name Last iS
Owner's Addres
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First
E-mail
Address
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City
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Zip
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Telephonef
( 4. Architect/Designer's
Architect/Designer's
Name Last
Address
First
Architect/Designer's
F
E-mail Address
Lic.
No.
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City E
State
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-- Zip
Telephone)
5. Engineer's Name Last
Engineer's Address
Engineer's
First
I
E-mail
Address
Lic.
No.
City I
State
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Zip
l
Telephone!
4
Contractor's
Lic. No.
E-mail Address
Class)
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OFFICE USE ONLY ENERGY P/C FEE $ PERMIT NO. /o'"7-P
GRADING P/C FEE $ FIRE P/C FEE S PLAN CHECK O. Sel-
Rev 4/16/09 ELEC/MECH/PLUM P/C FEE $ PLAN CHECK FEE $