HomeMy WebLinkAboutX2012-1192 - Permit Applicationa Print Four i -!!,
r. Comm I Residential
xZO12-
Worksheet for Building Combo Permit Application 1 6 i1a
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
y/ Building r-: Grading
f Drainage Elec ech lum CuYdCut CuvdFill
Project Address (Not mailing address) Floor Suite No
t G ((o SEA SELL
CL , I Cc.)rzCk-�A DOC- M Ar, 9 z.fO Z - F F—
Description of Work
Use
CZcaiil L ICITCIlGf1, d*tJl7 Mk15TC-�IjAT41
# Storiesl # Units (if Resf
Valuation$ C0
Material/Labor l %/
New/Add SFr�7
Remodel SF�—i Garage/New/Add � I
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
1 C,P►Ca � ��
6L,
City I CoYzc "l,17 t "AIK State F (A , Zip �3 ECG ZS Telephone - 7I °) -O 7'i7
APPLICANT'S NAME
Last tv gol:5� j First
Applicant's Address
Applicant's E-mail Address
ZZ4Z ✓, ls.P L i.»C
C:ttl26GV, 1= )/,VJY
City UJC—S l CC}\JI'(ti.3A,
State " : Zip �l'i�ll Telephone 2& �ye'-d' --7,
_-.._i
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip Telephone �dIVO'e tCgrV' L3t4OPO
ENGINEER'S NAME
---
r`/ - c. No.
Last _. _- / j First__.-q�(j)tb.��3 --
Engineer's Address
Engineer's E-mail Address
City
State—� Zip .._ Telephone�l
CONTRACTOR'S NAME/COMPANY Jk," C-S CLt20V C- Lic. No. 51Z5(v 5 Class
Contractor's Address
Contractor's E-mail Address
�`I'r3 �Y�P..Jp. r'L.. .J1aM✓rS-4 CA W, VE G 4-%13.L,�CCJC"J
City Gc�Vftv/b, --,-,_
-.-_, _ State I "' 1 Zip--Rl�Z3 - Telephone554. )14--4t,��
ENERGY P/C FEE $
FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $
PLAN CHECK NO. A 2-70,�
PLANNING P/C FEE $ --, '"LSa)I
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $