HomeMy WebLinkAboutX2012-0103 - Permit Applicationit,l?r;nt Form,
FI Comm'I [_ Residential
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Worksheet for Building Combo Permit Application Ipp QGIi S
City of Newport Beach -Building Division �� � , V t•
NOTE: ,PLAN CHECK FEE DUE AT TIME OF SUBMITTAL la n G�'� 'K
ui ing r Grading �.Draina KtI c F_Mech F—PlumCo Yd CutF_Cu Yd Fill y
oject Address (Not mailing ress) Floor Suite No
150� GUAIL IL S10 f-T .166b NNW-' Kfic�op
Description, Work
Use
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#Stories�l #Units (ifRes)�,
p�C�1h0 �t,}%pMS ( b, 4 y vc(e,--�-�
Valuation Fq;*
Material/Labor
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New/Add SFFi Remodel SF Garage/New,,/Add
OWNER'S NAME Last h�� �bb� W UAs-L i LFirst
Owner's Address Owner's E-mail Address
City Sw, (rtk"tISCb i State I A Zip Telephone
APPLICANT'S NAME Last d _ First OCla1�
A I N �1� A _ �r4 i
Applicant's Address .Applicant's E-mail Address
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City AN -I iAfff_M State CA. Zip � I��.b Telephon 714i.G�3-I+,ao
/DESIGNER'S NAME Last a Y � 0, v'�
. ,First Ail Wp 0V+ Lic. No.
Arcyhqitect/Designer's Address P<.SOvvt us NC Architect/Designer's E-mail Address
City State r Zip F Telephone N'
ENGINEER'S NAME Last N _. First 1 7 20'Uc. No
Engineer's Address Engineer's E-mail Ad9QXOrNEIA1e
City State F Zip F Telephone
CONTRACTOR'S NAME/COMPANY 5 W5C iV Lic. No. �I 6I Class F(fl�
Contractor's Address Contractor's E-mail Address
�a:o r ,C�rrzr tLPNC
City I".Ivd�W'�icti�'1 .._.__ State CA_.-. Zip.�-- Telephor(e
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO.
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $
P� LL s UI,IS r-1