HomeMy WebLinkAboutX2011-1052 - MiscExtg Building SF
Extg Gar sf
(— New
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Worksheet for Building Combo Permit Application
City of Newport Beach - Building Department
uilding fl Grading ("Drainage IT Elect" fIM ch i Plum
1. Project Address (Not mailing address)
I k{ �pcG LDS 41
Tenant Name(if Applicable) I
Floor Suite No
# Units (if Residential)
2. Description of Work 7 "66cd x 9c it X /551Actt,se
. Cci-itt H 01s-er--Eats ecuse4 tad O*
Demo Building SF (
Add
Demo Garage sf
ii Alter 1—Demo
Add/Reconstruct Bldg SF
Add/Reconstruct Garage sf
TOTAL BLDG SF
TOTAL GARAGE SF
/wisc
Valuation $ I
# Stories
Cu Yd Cut
Cu Yd Fill
U
Va
Check Appropriate Box for Applicant
r
3. Owner's Name
Owner's Address
Last
City
State
Zip
First
Owner's E-mail Address
Telephone
j— 4. Architect/Designer's Name Last . - �- First
Architect/Designer's Address Architect/Designer's E-mail Address
City I
State
Zip
Lic. No.
Telephone
( 5. Engineer's Name Last
Chien
First
H5; - tiw�
Engineer's Address Engineers E-mail Address
9-0-acY oZ17ID
City rernn \ e C �'t•
State LA
Zip
Lic. No.
2s3t
9 175'0
Telephone! i r _ 3 (yt) _ 39a$'
j�6. Contractor's Name Last
Contractor's Address /J@u,•ncr1-
3`10\ Sers3-1-r-cw.
City S&rc & Ar r State
AWYN. Cn
/atJ
First
Lic. No.
Co . Contractor's E-mail Address
CA
Class
Zip 9 ono`$
Telephoned(y _ 556-1ao
5
OFFICE USE ONLY ENERGY P/C FEE $ PERMIT NO
GRADING P/C FEE $ FIRE P/C FEE $ PLAN CHECK NO.
Rev 4/16/09 ELEC/MECH/PLUM P/C FEE $ PLAN CHECK FEE $
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