HomeMy WebLinkAboutX2009-0888 - Permit Applicationx2UUq_ot
Worksheet for Building Combo Permit ApVcati�on � p� NiGllr c((�e -
City of Newport Beach -Bullding Department K) ( S ^ ^ s
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Please print 3 copies °+�;,�, ,
0'§A �f1d { fVBu{Iding fyjGrading FDrainage EIec (",Meth Iy Blum
1. Project Address (Not mailing address) / O� 1-S41
�m_ (Ji msf— Cie Floor Suite No
Tenant Name(if Applicable) # Units (if Residential)
2. Description of Work ...5
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Use r�iief
.Extg Building
SF ^'�!% Demo Building SF
W m,
. t
1j "�. Add/ReconstructI Bldg SFC
...
F'i ery+ '+^'r^
Valuation $
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E,xtg.Gar sf
' 'y,[i Demo Garage sf
YYp- �„} Add/Reconstruct Garage sf '.:
# Stories
t New
Add Alter
TOTAL BLDG SF
memo
_) I 7, '
-
Cu Yd Cut 7 �^'
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TOTAL GARAGE SIF
tfa'' 4'
Cu Yd Fill p (
c
Check Annronriate Box for Annlicant
I 3. Owner's Name
Last C t (i t V a c t u nql�, 4k lgfgS, First i2 p Pa
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Owner's Address
Owner's E-mail Address
City re4(;IAL,,&1,,fiv
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State it/✓� Zip Cfc��t �� Telephone �vq ,� �,�, ✓� rf3
Architect/Designe'r+s Name Last 654,6 5—V First o Z M j Lic. No.
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Architect/Desi ner's.Address Architect/Desi ner-s-
g g E-mail Address `
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city
State,AcVOFNogi`p)A,NPJ1Nhoit4'o
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5. Engineer's Name
rt ]'1 A �,JF" aN G I T "t O i i R, ",i I F-�'-' - G
Last �Al, - , € �A� ,ocs +r Pf � �r
Lic. No.
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ro�plrc�uceNil clv�� t u, Lo.�r yr{e
IlYO)N(NFGnr R'F; �' dL{lti. SgHy OCU dr :'NI'
Engineers Address-
4E1IS , "r, nx I F rc '�yT� mall W19bYess -
99 y
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..= F0.D NANGE� S:P�`�SnhDPO'.
city 4✓
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State cam— e net —
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t76. Contractor's Name
Last o d ._ est Classmm
SFr
SAIDP --
Contractor'sAddress
f9N— Contractors E-m I Address
City
State Zip Telephone �i7u���1�
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OFFICE USE ONLY ENERGY
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P/C FEE $ �, 1, On PERMIT NO....li�GiJt.�i�t
GRADING P/C FEE $ ;.t''d,
..';e FIRE P/C FEE $ PLAN CHECK N0.
Rev4116109 ELEC/MECH/PLUM P/C FEE $ PLAN CHECK FEE