HomeMy WebLinkAboutX2010-2250 - Permit ApplicationWorksheet for Building Combo Permit Application
City of Newport Beach - Building Department
Please print 3 copies VL (-2,
Building F_ Grading (-",Drainage F_ Elec Mech Plum
1. Project Address (Not mailing
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Tenant Name(if Applicable) F77777777777.....-
A 20 10--225-6
32,324 6 1 CA Y St
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Floor Suite No
: [---I- F_
# Units (if Residential) F
2. Description of Work
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Use
7,5
E t�!]F, Min 9 SFF
Demo Building SF
F
Add/Reconstruct Bldg SF F
Valuation $
Extg Gar sf
Demo Garage sf F77
Add/Reconstruct Garage sf F_
# Stories
77 New Add
Alter ('DemoTOTAL
BLDG SF F
Cu Yd Cut F
TOTAL GARAGE SF F_
Cu Yd Fill
F 3. Owner's Name Last
Firs t
Owner's Address Owner's E-mail Address
FT_
�-oD
F
City State zip qXA/,Q
: Telepho P0
F_ 4. Arch itect/Designer's Name Last F-First F-. Lic. No. F
Architect/Designer's Address
City
F_ 5. Engineer's Name
Architect/Designer's E-mail Address
State Zip = TelephoneF
Last 17777777777 First E77777 Lic. No. F
Engineer's Address Engineer's E-mail Address
City State [777 Zip Telephone mmT
X\6. Contractor's Name Last
First Lic. No. W-61B_1 Class F
Contractor's Address Contractor's E-mail Address
City State Zip Telephone
OFFICE USE ONLY ENERGY P/C FEE $
GRADING P/C FEE $
FIRE P/C FEE $
PERMIT NO.
PLAN CHECK NO.
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MN
Rev4116109 ELEC/MECH/PLUM P/C FEE $
PLAN CHECK FEE $