HomeMy WebLinkAboutX2011-1510 - Permit ApplicationWorkshee ling Beach
Combo Permit Application
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Building Department N!elwlpe!
Please print 3 copies
[Mg,.Bui ing Grading F-Drainage ;K Elec F-. Mech r—. Plum
1. Project Address (Not mailing address)
1,"160 47- #If h tv 9 7e.r 6>
Tenant Name(if Applicable) C D MOA Y,5 & IA &Fg N ? Y
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26C)o Coa5j- 11,gy
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Floor Suite No
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# Units (if Residential)
�rl4escrjption of Work Use
1''A A L,,
. .. . .. ij�! 1 /Y., 8-re7p-
Valuation $
wilding SF Demo Building SF Add/Reconstruct Bldg SF
It Z F777
Extg Gar sf F_ Demo Garage sf Add/Reconstruct Garage sf F_ # Stories F_
TOTAL BLDG SF
r7 New F_ Add Alter F—Demo I I : Cu Yd Cut
TOTAL GARAGE SF . Cu Yd Fill F-
3. Owner's Name Last %First
Owner's Address Owner's E-mail Address
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City jorAt At ktto State Fc W :Zip F?V-2 _10 Telephone b /1 _,�Z
F.- A. Architect/Designer's Name Last First Lic. No.
Contractor's Name Last
Contractor's Address
First FW��7 Lic. No. Class
Contractor's E-mail Address
City State G zip T e phone
OFFICE USE ON ENERGY P/C FEE $ PERMIT NO.
IT No
GRADING P/C FEE $ FIRE P/C FEE $ PLAN CHECK NO. 12-
Rev4116109 'Q2�j I � — CHECK No ' 2
ELEC/MECH/PLUM P/C FEE $ i_65 PLAN CHECK FEE $ _ —lp,), [�}