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HomeMy WebLinkAboutX2012-0349 - Permit ApplicationX201 z 051q 9Fq cl)(HANNy- Print Form Worksheet for Building Combo Permit Application, (— Comm'I [— Residential City of Newport Beach - Building Division v NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL KBuilding (�I Grading f-'Drainage W',Elec R?Mech yPlum cu yd c,,F Cu Yd rill Project Address (Not mailing address) Floor Suite No Description of Work Use o-Slp6 # Stories #Units (if ResfI Valuation / o o Material/Labor New/Add SF a�Q Remodel SF � Garage/New/Add 4 OWNER'S NAME Last First AJ(2 de r- Owner's Address Owner's E-mail Address 83 our a D City 60(D--Ka State �_-...._ Zip 1 &31Z Telephone-l�Y....l.-����..Od APPLICANT'S NAME Last �1 First Applicant's Address Applicant's E-mail Address G A_ pf CS"� � AA &ROW)� � jL City�(U}.`� ..-._.1 State la.. Zip Telephone `�C4 V ARCHITECT/DESIGNER'S NAME Last A First Lic. No. G - ( 0 f� Architect/Designer's AddressI `I Arch itect/Designer's E� City i State Zip F Telephone ENGINEER'S NAME Last First 1 Lic. No F—! Engineer's Address Engineer's E-mail Address City State F_ Zip f— Telephoned CONTRACTOR'S NAME/COMPANY Lic. No. Class Contractor's Address Contractor's E-mail Address City State r----, Zip F� Telephone ENERGY P/C FEE $ © HRnt-P/C FEES 7_5 NO. GRADING P/C FEE $ YW a,) PLAN CHECK NO. 2ii+ PLANNING P/C FEE $ D� ELEC/PLUM/MECH P/C FEE $ B PL11 gg 77�nqqry AN �FfL=CK FEE $ 523, rCI DEVELOPMENT # TOTAL FEES PAID $ Y D-