HomeMy WebLinkAboutX2021-1526 - Permit ApplicationPrint Form
X __ �'I r Residential
Worksheet for Building Combo Permit Application
City of Newport Beach - Building Division 4 g
NOTE: PLAN CHECK FEE DUE AT TIMF nF SI IRMITTAI
XBuilding (— Grading r—Drainage XElec ( Mech r Plum cuYdCut F cuYdFill F
Project Address (Not mailing address)
Floor Suite No
12750 West Coast Highway
--
Description of Work
Use �q�
Exterior Lighting Upgrade: Install
(4) pole mounted fixtures. Install
(6) canopy mounted fixtures.
I"
Replace (7) canopy mounted fixtures Replace (9) wall mounted fixtures
Remove (1) flood
# Stories #Units (if Res 0�
imounted fixture -patch & paint. Remove (2) fixtures
canopy mounted
-patch & paint. Remove (1
Valuation
Material/Labor[201.000.00
- -�-�-
New/Add SFjO Remodel SF10 `_
-
Garage/New/Add c
OWNER'S NAME Last Wells Fargo
First
Owner's Address
Owner's E-mail Address
1 Home Campus, 5th Floor
City Des Moines State IA
Zip 50328 Telephone (915) 852-6156
APPLICANT'S NAME Last Henrie
First Timothy
Applicant's Address
Applicant's E-mail Address
150 Red Mill Road
Timothy.Henrie@bureauvedtas.com
City Bloomsburg State Pa
Zip 17815 Telephonei(570) 560-3081
ARCHITECT/DESIGNER'S NAME Last
First—s Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State �—
Zip F Telephone'(
ENGINEER'S NAME Last OSander
First Weir I Lic. NoC66470
Engineer's Address
Engineer's E-mail Address
102 Farnsworth Avenue
Independence@indepeng.com
City'Bordertown State NJ
Zip 108505 Telephonel(609) 49 -9369
CONTRACTOR'S NAME/COMPANY Cennox
Lic No. 921843 Class CIO
Contractor's Address
Contractor's E-mail Address
I 13010 Santa Fe Ct
I
City (Missoula State M[
Zip �59808 Telephonel(915) 8 66
ENERGY PIC FEE $ FIRE P/C FEE $
PERMIT NO.
GRADING PIC FEE $ PLANNING P/C FEE $
PLAN CHECK NO.
k
I ELEC/PLUM/MECH P/C FEE $
IL
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $