HomeMy WebLinkAboutX2012-0898 - Permit ApplicationPent �orrr� l/ / Worksheet for Buildin ombo Per
mlt�Ap lication
Comm'I F_ Residential City of Newport Beach - Building Division %��!�
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMI lAL
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7�01 Goa sf-j+Nj W
-1 t . \�.%
rBuilding r, Grading rDrainage f—Elec F_ Mech Plum CuYdCut CuvdFill F
Project Address (Not mailing address) Floor Suite No
CO3.,T-__
Description of Work
Use
>It2.D\� SI I>NS Er_—� ®F E?h k SIbN lK
# Stories # Units (if Res)
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— —-----—Qh( _f f--Salo�J- ��J.�QI_?4�=
Valuation
Material/Labor
New/Add SFF_'. Remodel SF Garage/New/Add
OWNER'S NAME Last _'1 �1 First
Owner's Address Owner's E-mail Address
City Lea Vj State �(v Zip CJl r ll'I lilt Telephoner
APPLICANT'S NAME Caste- First
Applicant's Address Applicant's E-mail Address
pI �GG o5g 'SI CAE ^ `�dk Cp 1
C!y3 State �C l Telephone
_� Zip
ELM !` I'!_2�aS._ IIN'1 Wgi^dZ`�
ARCHITECT/DESIGNER'S NAME [�
Last � �NOF� First r�Q�'1 Lic. No. F��,
Architectct/Designeerr,'�s,Address Architect/Designer's E-mail Address-
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City IQ'dl-nlE..------- --_.- State 1 Zip.."Daly..... Telephon �.J..-Zs%"J?{��
ENGINEER'S NAME Lic. No.
Last --- _. - -.,.. First ...
Engineer's Address Engineer's E-mail Address
City State �— Zip ......_ Telephoned--,;
CONTRACTOR'S NAME/COMPANY Lic. No. $2 31J
Contractor's Address Contractor's E-mail Address
D
City C�� mE - State i-_ —.-.; Zip 9/_ _.-...' Telephone
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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 $