HomeMy WebLinkAboutX2011-1756 - Permit ApplicationPlease print 3 copies
-•24orksheet for Building Combo Permit Application
(Building
City of Newport Beach - Building Departments r ^
Grading f-Drainage
'Elec
Mech
Plum
1. Project Address (Not mailing address)
cc Plt 49AG T. 12 N r✓
Tenant Name(if Applicable)
Floor
Suite No
# Units (if Residential) f
2. Description of Work
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Extg Building SF[ Demo Building SF
Extg Gar sf
Demo Garage sf
New fl Add f••. Alter (Demo
Add/Reconstruct Bldg SF
Add/Reconstruct Garage sf
TOTAL BLDG SF
TOTAL GARAGE SF
Use
Cu Yd Cut
Cu Yd Fill
Check Appropriate Box for Applicant
f- 3. Owner's Name Last
Address
Owner's
First
E-mail
rap i r G •
Address
rOwner's
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City 1
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State
CA
Zip
elC
Telephone]
P 4. Architect/Designer's Name Last
Architect/Designer's Address
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First
Architect/Designer's
Jo IpEj
E-mail Address
Lic. No.IGedi5
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City
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State
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Zip
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Telephone[
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f- 5. Engineer's Name Last
Engineer's Address
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jT
Engineer's
First
PA-0
E-mail
L.p
Address
Lic No.
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6. Contractor's Name L. t)
1/(4'(aI S-e4 .
Contractor's Address
s First
C(r sr
/ Contractor's
i. ''WO c" Li
P
ere
g-mail sddress
'Class
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City--
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rg St.
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go%rSU
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3,,-Jl OLejS
Tele..one
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OFFICE USE ONLY ENERGY P/C FEE $ 5 PERMIT NO. � I)
-1.75Ip
GRADING P/C FEE $ FIRE P/C FEE $ PLAN CHECK NO. I S 3 --in I 1
Rev 4/16/09 ELEC/MECH/PLUM P/C FEE $ Z4,05
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PLAN CHECK FEE $ 31p
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