HomeMy WebLinkAboutX2012-1383 - Permit ApplicationtForrritt... Worksheet for Building Combo Permit Application��
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omm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
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)(,E uilding r - Grading F"Drainage F Elec (— Mech ; Plum CuYd Cut i Cu Yd Fill
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Project Address (Not mailing address)
Floor Suite No
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Description of Work
Use
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(a� Loa §ii nJ) ��� �C'V1C@V1� � I�
# Stories # Units (if Res)'
1
Vaterialn$
Material/Labor
/Labor
New/Add SF Remodel SF �li Gara e/New/Add ��
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OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City lw`�� -...._ .......� State FCA- Zip . `I PP 17- TelephoneW...
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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City-1n-��(..i( l./ _. State Y-Zlp �61�rC�___—� Telephone"lU"l'-,4(C?(]'°ZLJ,
ARCHITECT/DESIGNER'S NAME Last F First F Lic. No:
Architect/Designer's Address - Architect/Designer's E-mail Address
City - _ t — State F Zip F Telephone—,
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City , ' State F Zip F _ - Telephone_
CONTRACTOR'SNAME/COMPANY W�l� Si�V1 IhG i Li -
c. _ NW�f
— o. Class
Contractor's Address Contractor's E-mail Address
City �.�,�(�.-__-._.._ State-- ( Zip (�(� Telephone
1 q(l-�kl�b-:?6
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.--r"
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO.
ELEC/PLUM/NYECH PIC FEEE$ PLAN CHECK FEE $
DEVELOPMENT # D 16 1/1,'O an -: S_, OTAL FEES PAID $