HomeMy WebLinkAboutX2011-2856 - Permit Application2 "7 Worksheet for Building Combo Permit Application
® @ 9 � t ",11, City of Newport Beach - Building Department
Please print 3 copies 57
(-';Building F_. Grading [7.Drainage r- Elec FMech F-, Ilum
% 2011 -
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1. Project ress( ailing addr Floor Suite No
Tenant Name(if Applicable) Units (if Residential)
............. .
2; Description of Work Use
NP
Valuation $
Extg,Building SF Demo Building SF Add/Reconstruct Bldg SF C?-V—
Extg Gar sf Demo Garage sf Add/Reconstruct Garage sf F_ # Stories
.... . .. .. . .. .
Add 17 Alter F-.Demo TOTAL BLDG SIF f Cu Yd Cut
r New F i F
TOTAL GARAGE SF Cu Yd Fill r
3. Owner's Name Last First
Owner's Address Owner's E-mail Address
. . ... ......... ... ... .. .. ... ... ... .... .. ... .. ..
I I —
5�z(-,60 Telephone 1
. %W 1 46-�
City State Zip
F- 4. ArchitecVDesigner's Name Last lw///r, kif
2
Architect/Designer's Address
City State
First
Lic. No.
Architect/Designer's E-mail Address
.. .... .. ... ... ... .. .. .. .. .. .. ... . .. . .. .... ..
Zip Telephone[
5. Engineer's Name Last FV7�c,�� First Lic. No.
. . ... .... .. .. .. .. . ... F77777
Engineer's Address Engineer's E -mail Address
....... .... ..
... .... .. .. ... .. .. ... .. ... ... .. ... .. .. ... ... .. . .... .. ... ... ... ... .. ... .
city State F" Zip Telephone
F_ 6. Contractor's Name Las First Lic, No, Class
IYe tcA4)J �5 5D
Contractor's Address Contractor's E-mail Address
Fr/3/ _AI�44,6�
State Zip Telephone
City r? 566
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OFFICE USE ONLY ENERGY P/C FEE $ PERMIT NO. - V-7&u. ?-Ko
GRADING P/C FEE $ FIRE E!Et�A2 PLAN CHECK NO.,
Rev 4116109 ELEC/MECH/PLUM P/C FEE$ PLAN CHECK FEE $