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XR2023-0258 - Permit Application
Comm'I [Residential [Building Worksheet for Building :Combo Permit Application City of Newport Beach - Building Division NOTE-' PLAN CHECK FEE DUE AT T1neG nr I Gradin - - "'""' 1HL g [Drainage r Elec r Mech F Plum Cu Yd Cut Address (Not mailing address) F,- CuvdFill Of Work Floor Suite f - - New/AddSFF� RemodelSFF� --- - -- - - - _ _ Garage/New/Add F� OWNER'S NAME _ Last //�� ---- --- - - --V_1n/Pp2i_ UG,�yS< -- Owner's Address First Owner's E-mail Addresszal - City ---- 22 State - ..._..- - �'- - - Zip -_.I L 6C2z Telephone / APPLICANT'S NAME 4 9©1 Last _ - Applicants Address - _- -� �-�---�------� First Applicant's E-mail Address city ' . -- h/CruSrwYti}.Co N State --_._...._. Zip -I ' Telephone �(FO/1,41, ARCHITECT/DESIRNco,c ...... - Last Architect/Designer's Address - City State L.IQlaerm. .. Use # Storiesr, # Units (if Res)[ Valuation $ t Material/Labor ! 0 1 t7 0� First F7 v Lic. No. Architect/Designer's E-mail Address - Zip Telephoned Last Y __ _ First 5' Engineer's Address �- - - - - - ---- Engineer's E-mail Address City . 00 If� _4. -- �- f ._ 0, State I CONTRACTOR'S NAME/COMPANY Zips _ 7p TelephoneF-77/ Lic. No. VS Contractor's Address Lic. No. %� ClassFE - � -- - _------------. Contractor's E-mail Address n - - - - City "t�i--------- State �%._--- -- Zip _ 17 7 ()T Telephone %I 4 C 2 Q 1 1 R f ENERGY P/C FEF R GRADING P/C FEE $ PERMIT NO.Z�3_UzS�i '�— PLANNING P/C FEE $ ELEC/PLUM/MECH P/C FEE $ — PLAN CHECK No. DEVELOPMENT # PLAN CHECK FEE $ TOTAI FFPQ DAin a