HomeMy WebLinkAboutX2011-1974 - Permit ApplicationAX43 X 201I " 1`1 `t
Worksheet for Building Combo Permit Application �, ��® t
prirY�DlfXf ; City of Newport Beach - Building Department
Tease print 3 copies
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1. Project Address (Not mailing address) v Floor Suite No,
[11951 PORT LOCK8LEIGH PLACE F— l
Tenant Name(if Applicable) # Units (if Residential) 1 1
2. Description of Work
Use
Valuation $ 5 t10D
Extg Building SF 393 Demo Building SF /�A : Add/Reconstruct Bldg SF 32 ,.
Extg Gar sf 20 Demo Garage sf �A —i Add/Reconstruct Garage sf /A
TOTAL BLDG SF
New r,, Add r Alter '!Demmo 525 Cudcut
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TOTAL GARAGE SF 220 —.',, Cu Yd Fill
-hnrk Annrnnrl2fa Rnr fnr AnMinant
# Stories
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Owner's Name Last��
IPSER First EAN &•ATE@
Address
Owner's E-mail Address _
Owner's
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PORT LOCKSLEIGH PLACE
City IUEV(.VPORT BEACH
State EA Zip 2660 Telephone 949) 640-0479
j-X 4. ArcPdtect/Designees Name
Last AMPTON First RAIG Lic. No. IA
Architect/Designees Address
Architect/Designees E-mail Address
8 WItALLARD COURT
raigshampton(a)comcast.net
City MAGALIA
State FA_—Q Zip 5954 Telephone g49)209-8883
5. Engineer's Name Last
6BES First ALb E Lic. No. E30407
Engineer's Address
Engineer's E-mail Address
800 E. 16TH STREET—��
City ANTAANA
State [--��Z"ip 2701 Telephone 714) 835-2800
I'� 6. Contractor's Name Last ,p,� &,'�7AnFirst Lic. No.
--II
Contractor's Address Z.,a"p�'
Lc^.�257• �aUPZv Contractors E-mail Address J&�,•Z(/��/I,(y( We,4 r
City
State Zip Telephoner
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OFFICE USE ONLY ENERGY P/C FEE $ PERMIT N0.--W� /^,
2gA61
GRADING P/C FEE $
FIRE PIC FEE $ LAN CHECK NO. 1 r -
Rev4116109 ELEC/MECH/PLUM P/C FEE $ PLAN CHECK FEE $ b6Q .
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