HomeMy WebLinkAboutX2010-3082 - Permit ApplicationPlease print 3 copies
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Worksheet for Building Combo Permit Application
City of Newport Beach - Building Department 6
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1. Project Address (Not mailing address)
Tenant Name(if Applicable) I
2. De5qnpflon of Work
Extg Building SF Demo Building SF Add/ReconstruVBidg SF F77
Extg Gar sf F_�Vio Demo Garage sf 177 Add/Reconstruct Garage sf F
TOTAL BLDG SF
[7 New Add FVIAIter (!,Demo
TOTAL GARAGE SIF F
f7 3. Owner's Name Last I Sec kea,
Owner's Address
/090
City e'a&e- Ae State Fe A
mm
F_ 4. Architect/Designer's Name Last
Architect/Designer's Address
91a
City State
Floor Suite No
F_'
# Units (if Residential)
Use I .5r-
Valuation $ F2�6, two
# Stories IT
Cu Yd Cut
Cu Yd Fill
First
104"irx
Owner's E-mail Address
[(Pk &W C1 k Ct It J eA 44A A - 12-e e.,4 e1c.
Zip r Telephone 9 1/o - 7/7 - iltIV7
FirstFP_Ef --k Lic. No.
Architect/Designer's E-mail Address
Zip F(�6-7os— Telephonel7W I Srol 1 oko,�?
5. Engineer's Name Last First, ic No Fe 4. —,/o 7
Engineer's Address
City State 0i
Engineer's E-mail Address
zijd5-76/ Telephone�jt(43.5_ �_Cz
F- 6. Contractor's Name Last Atr L e_A First Lic. No.F?4,34,?Y classW7�� -5
Contractor's Address
City State 56�7
OFFICE USE ONLY ENERGY P/C FEE $
Contractor's E-mail Address
. . .... .. ..
Zip Telephone W? -�-i -
PERMIT NO.
GRADING P/C FEE $ FIRE P/C FEE $
Rev4176109 ELEC/MECH/PLUM P/C FEE $
PLAN CHECK
PLAN CHECK FEE $