HomeMy WebLinkAboutXR2023-0251 - Permit ApplicationPrrrg,S7 Worksheet for Building Combo Permit Application
[— Comm'I Residential City of Newport Beach - Building Division
N CCC _ NOTE' PI A ( IF( t! nl IC n r Ti.. 1,
- -- - - •�-- .+�� r, i i uvic Ur OUMVII I I AL
[Building r Grading f—Drainage r Elec j— Mech r Plum Cu Yd Cut �. Cu Ytl Fill F
Project Address (Not mailing address)
Floor Suite No
Description of Work
Use
# Stories, # Units (if Res)FT
Valuation $ Ill DD O
Material/Labor
New/Add SF� Remodel SF
Garage/New/Add
OWNER'S NAME Last pp{�_
_L1L�=_W ft( i C(7-r:-:__ST FirstF (�
Owner's Address
Owner's E-mail Address
__ S
City — �` State— �
+V -- ZiP i4'� 3 Telephone��
APPLICANT'S NAME Last
First
Applicant's Address
-
Applicant's E-mail Address
City IVNf+ -- — State
��'T �—
Zip �%��-. Telephone
+ r
ARCHITECT/DESIGNER'S NAME Last First Lic.
Architect/Designer's Address
No. �—
Architect/Designer's E-mail Address
City State
---------------
Zip �— Telephoned—i
ENGINEER'S NAME Last
First N� Lic. No. S> iiW9
Engineer's Address
Engineers E-mail Address
City f (il i
-- � NT �- Ndl State
p /
ZIP ZO_ — Tele hone `�/ (� b �
CONTRACTOR'S NAME/COMPANY — Lic. No. 7(+•[_ I '
N(ytJS `r-N (�otvS(_ Class
Contractor's Address
Contractor's E-mail Address
123 4 l -OW(4 bN
City N State
ZIp �7.p5 Telephone L411
ENERGY P/C FEE $ FIRE P/C FEE $
PERMIT NO. �ZQ L`�_ (JZS ,
GRADING P/C FEE $ PLANNING P/C FEE $
PLAN CHECK NO.
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TnTAl FFFc PAID