HomeMy WebLinkAboutX2009-1256 - Permit ApplicationWorksheet for Building Combo Permit Application
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F'rtnf I"ortTt City of Newport Beach - Building Department
Please print 3 copies
XU0q 119
(';Building r Grading (" "Drainage F Elec f" ` Mech — Plum
1. Project Address (Not mailing address)
Floor Suite No
F .. :
Tenant Name(if Applicable)
_ # Units (if Residential)
2. Description of Work
f I
u/ ... ............
lc��%� i�..... ................... .............. ,
Exist House SF Demo House SF Qd /Reconstruct House SF
......................
Exist Gar SF Demo Garage SFF777
1IV New F. Add (-"i Alter [—Demo
Add/Reconstruct Garage SF
TOTAL HOUSE SF
TOTAL GARAGE SIF
'heck Appropriate ttox Tor Applicant
3. Owner's Name Last First
..................................................................................................................................................
..-. -
Use
r......
Valuation $
# Stories F7
Cu Yd Cut F77
Cu Yd Fill F77
Owner's Address Owner's E-mail Address
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City State t Zip Telephone �j( r� ��.
... �._ . _ _ o...... ���......................................
F- 4. Architect/Designer's Name Last yC First Lic. No......................
6. Contractor's Name Last FirstF Lic. No. Class f5
Contractor's Address Contractor's E-mail Address
. .................................... ............ .......................................................................... ..... .. ........... ......................
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City �—A,�l State �' Zip Telephone
..7... `...
OFFICE USE ONLY ENERGY P/C FEE $ PERMIT NO.
GRADING P/C FEE $ PLAN CHECK NO.
Rev 1118107 ELEC/MECH/PLUM P/C PLAN CHECK FEE $