HomeMy WebLinkAboutX2010-3066 - Permit Application4 _4 -
pr,nt Form Worksheet for Building Combo Permit Application
EW
Please print 3 copies City of Newport Beach - Building Department
uilding Grading ('Drainage b6lec rVA.,6 A,-"'
1. Project Address (Not mailing address)
Tenant Name(if Applicable)
2..Description of
Extg Building SF
1/0 105CDeMO Building SF
Ext9 Gar sf Demo Garage sf
New 17 Add YAlter )Kemo
N3. Owner's Name Last
Owner's Addr
ess
City
State
1 4. ArchitectlDesigner
's Name Last
FArchitect/Designer's Address,� _zja__r�__ fit ,ar,�
City
State
F
Add/Reconstruct Bldg SF I
Add/Reconstruct Garage f
TOTAL BLDG SF F77
TOTAL GARAGE SF
0</5- Engineer's Name
Owner's E-mail Address
Zip
Teleh poneF
Floor Suite No
# Units (if Residential)
I
Use
Valuation $5j7�ri
Cu Yd
Cu Yd Fill
# Stories IT7
k-M 171,etz�7sl
'11c. No.
Architect/Designer's E-mail Addres s
Zip Cq— Telephone
Last
t
Engineer's Address .............
city
State
r,-.. 6. Contractor's Name Last
Contractor's Address
City
OFFICE USE ONLY ENERGY P/C FEE $
GRADING P/C FEE $
Lic. No.
Engineers E-mail Address
r------------- ---
Zip 5�L( 6 T elephone
First
Lic. No.
Class
Te701*TSr0AsMnn1 ail AEress
State
Zip
Telephon e
I Rev 4116109 ELEC/MECH/PLUM P/C FEE $
2E— PERMIT NO. _,j� C) I
FIRE P/C FEE $ PLAN CHECK NO.
PLAN CHECK FEE $