HomeMy WebLinkAboutX2011-1875 - Permit Applicationy Worksheet for Building Combo Permit Applicatior
Print Form City of Newport Beach - Building Department
Please print 3 copies
Building 7 Grading F-Drainage Elec F-,, Mech f Plum
1. Project Address I
Tenant Name(if Applicable)
')U 0" 11 l brT�
F 1 \iD
Floor Suite No
F
# Units (if Residential)
2. Description of Work
Use F.
Extg Building SFF_�
Demo Building SF F-
Add/Reconstruct Bldg SF
Valuation $�, .. ,
Extg Gar sf �'�,,,,
Demo Garage sf
Add/Reconstruct Garage sf
# Stories,,
New � Add
(mm Alter j',Demo
TOTAL BLDG SF
111 _..
Cu vd Cut ,
TOTAL GARAGE SF F
( Cu Yd Fill I
F_', 3. Owner's Name Last�R( First
Owner's Address Owner's E-mail Address
� ...
City �� ,�>� 0 State �' Zip I P I C1 -` Telephone
4. Architect/Designer's Name Last First �� t Lic. No.
Arc cUDesigner's Address Architect/Designer's E-mail A ds
City
State
Zip
Telephone ".
f__ 5. Engineer's Name
Last
_..
First
Lic No
r ontractor's Name Last �; First � 171 � Lic. No. -7 Class a jZ
ontractor's Address Contractor's E-mail Address
City iiv f.vl State J o� Zip -`7 L 6/ �_ Telephone
OFFICE USE ONLY ENERGY P/C FEE $ J/"/Oj I
GRADING P/C FEE $
PERMIT NO.�y
PLANCHECKNO.
Rev4116109 ELEC/MECH/PLUM P/C FEE $
PLAN CHECK FEE $