HomeMy WebLinkAboutX2008-1528 - Permit Applicationr
Works
Print Form
Please print 3 copies
Building
:t for Building Combo Permit Application
City of Newport Beach - Building Department, l glrloQ
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F Grading
1. Project Address (Not mailing address)
Elec Mech Plum
[—.Drainage jm .
Tenant Name(if Applicable) % z- 7G/Iio�C
2. Description of Work
'7"?1T 2�
Exist House SF 16e�Q Demo House SF I
.... i..................................
Exist Gar SF Demo Garage SF
F77
F New F Add
Check A ro riate Box for
F- 3. Owner's Name
F. Alter '";Demo
House SF 1 60S
Add/Reconstruct Garage SF
TOTAL HOUSE SIF
TOTAL GARAGE SF
® First
Last ".... '
Owner's Address-
o`z L
............................
City State...............
e
4. Architect/Designer's Name
� aEvrvoRr
o m�
u =
C-�GIFb M1�`'
Floor Suite No
# Units (if Residential)
..............................
Use
Valuation $
# Stories
Cu Yd Cut
F77
Cu Yd Fill F77
Owner's E-mail Address
........................................... .
Zip cj�n� Telephone (7 /
Last First ,��/
..................................................................................................... -
Architect/Designer's Address
/..d.. .................. ......... ............... .......................................... ................
:
City
State
Lic. No.
Arch itect/Designer's E-mail Address
Zip F�7Telephone ..............
First Lic. No.
5. Engineer's Name Last �'� 7
Engineer's Address
City StateF777
.....................................................................................................:
Engineer's E-mail Address
..................................................................................................................
............................................................
ZipF77 .............
Telephone
6. Contractor's Name Last ' — y First Lic. No. 73c��4• ss
....................................... .
Contractor's Address
........... .
City StateEW7:
... V..f..�..?:T ...........
OFFICE USE ONLY ENERGY P/C FEE $
Contractor's E-mail Address
F 7
Zip Telephone l,. ews -V/Iz- -.
PERMIT NO.
GRADING P/C FEE $
Rev 1118107 ELEC/MECH/PLUM P/C
PLAN CHECK NO.
PLAN CHECK FEE $