HomeMy WebLinkAboutX2010-2376 - Permit ApplicationPrint Form Worksheet for Building Combo Permit Application zEW�R>
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City of Newport Beach -Building Department J Zo
Please print 3 copies /y
Building J- Grading (-Drainage j-" Elec ("`", Mech F`" Plum
1. Project Address (Not maili
Tenant Name(if Applicable) 3 �j�a-` W-,
2. Description of Work
I I
Extg Building SFDemo Building SF F Add/Reconstruct Bldg SF E
Extg Gar sf F Demo Garage sf Add/Reconstruct Garage sf
TOTAL BLDG SF
F_ New F— Add r. Alter F_ Demo
TOTAL GARAGE SF i
Chorlr Annrnnri ofu Rnv fnr Annlir•s n}
Floor Suite No
�.- F_--m-_-
# Units (if Residential) F
Use
Valuation $
# Stories F
Cu Yd Cut
Cu Yd Fill3
F 3. Owner's Name Last �
First F w
Owner's Address
_
Owner's E-mail Address
City � _ State
F_
Zip F_Telephone��
(— 4. Architect/Designer's Name Last
!. First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
7
Zip F_ Telephoned
F- 5. Engineer's Name Last
First Lic No.,
Engineer's Address
Engineer's E-mail Address
City �— State
F_
Zip Telephoned
6. Contractor's Name Last
First F Lic No. �� Class'
Contractor's Address
i
Contractor's E-mail Address
3
City State
F_'
-Zip F� Telephoned
OFFICE USE ONLY ENERGY P/C FEE $
PERMIT NO.
GRADING P/C FEE $ FIRE
P/C FEE $
PLAN CHECK NO.
Rev4176109 ELEC/MECH/PLUM P/C FEES
PLAN CHECK FEE $