HomeMy WebLinkAboutX2007-1463 - Permit Application (6)WORKSHEET FOR GRADING/DRAINAGE PERMIT APPLICATION
}FWzr�r CITY OF NEWPORT BEACH
BUILDING DEPARTMENT
PLEASE PRINT OR TYPE 9""""F
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
FLOOR
SUITE NO.
LEGAL DES RIPTION ,�j ,
LOT 5 BLOCK TRACT
No. UNITS
2. DESCRIPTION OF WORK j�'AZ fL� O 9%�
-f/)D &)-J7-i
ol
ESTIMATED $ VALUATION
IS THIS SITE VACANT?
ROUGH GRADI PRECISE GRADING DRAINAGE ❑',
CUBIC YARDAGE FOR ROJECT: FILL: CUT:C�
r
Check Appropriate Box for I
❑ 3. OWNER'S NAME
LAST
FIRST
g
ADDRESS
OWNER'S E-MAIL ADDRESS
(::�d lz,,7 kdr-ID PA
CITY
STATE
ZIP
PHONE NO.
❑ 4. ARCHITECT/DESIGNER'S NAME
LAST
(4,- Y
FIRST
f->
LIC. NO.
-7
ADDRESS
ARCHITECT/DESIGNER'S E-MAIL ADDRESS
�121 1�0
%� jG 9 `/Gv� C fvOC- .
CITY
/91
STATE
a
ZIP
5 U '-2-
PHONE NO.
7Aq---/,4`-7a
❑ 5. GEOTECH CONSULTANT'S NAME LAST
FIRST
LIC. NO.
ADDRESS
GEOTECH'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
�- % J % 9�� Y7�
A
C /d1
3 6F
j
7/ (-I-_r2,)— �0
❑ 6. CONTRACTOR'S NAME
BUSINESS LIC.
STATE LIC.
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
OFFICE USE ONLY
APR
PERMIT NO.
PLAN CHECK NO. .R
Exc\Forms\Grad_appllcation 12/2003
PLAN CHECK FEE $
q 9 dy r � °i PLAN CHECK ENG.'
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