HomeMy WebLinkAboutX2007-1463 - Permit Application\ Worksheet for Building Combo Permit Applies o -� WPo�
�'b City of ewport Beach - Building Department
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Please print 3 copies �6_, 00r , /� �►AS C c)00 ` o ��. I�
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Building (-" Grading Drainage Elec Mech Plu
1. Project Address (Not mailing address) Floor Suite No
Tenant Name(if Applicable) �0 V10 ILkL_) Q~(- #Units (if Residential)
2. Description of Work ® ff
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Valuation $ `1
Exist House SF Demo House SF Add/Reconstru o1ouse'SF- ® _
3� q �{09
Exist Gar SF 5 % Demo Garage SF i V Add/Reconstruct Garage SF # Stories (-(—
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\/' TOTAL HOUSE SF � .0 S—I Cu Yd Cut .
New (�! Add (""" Alter [—,Demo -- ---
`/^� TOTAL GARAGE SF L� Q Cu Yd Fill
Box for
r . Owner's Name
Last _ 1" 0 LL L VT_ First S e
Owner's Address
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City ��--G rV1Ikg--i State C.A
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Owner's E-mail Address
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Zip q2..$` Telephone
( 4. Architect/Designer's Name Last C/k First Lic No
Architect/Designer's Address
City State G A
Architect/Designer's E-mail Address
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Zip q•� Telephone
[71 5. Engineer's Name Last 4I.M.� Ai L. _ , First U � �� Lic. No.
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Engineer's Address
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.-..-. City State
PD 2 �" 1ry-1 F
Engineer's E-mail Address
Zip 0 Telephone ql/� d-41 ia /
f- 6. Contractor's Name Last�p FirstD� Lic. No. Class
Contractor's Address
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City State I CA --
Contractor's E-mail Address
Zip Telephone q jJ ?T7Z%?
OFFICE USE ONLY ENERGY P/C FEE $ PERMIT NO. rX_ aoo-7
GRADING P/C FEE $ PLAN CHECK NO.
Rev 1118107 ELEC/MECH/PLUM P/C PLAN CHECK FEE $