HomeMy WebLinkAboutX2012-1475 - Permit ApplicationWorksheet for Building Combo Permit Application %3ci
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Comm'I Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
,Building rGrading F—Drainage f-Elec r"j Mach 17Plum Cu yd Cut F Cu Yd Fill
Project Address (Not mailing address) Floor Suite No
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Description of Work
Use C
# Stories # Units (if Res)11
Valuation $
Material/Labor
New/Add SF 7 Remodel SF F77777 Garage/New/Add F—
OWNER'S NAME �—/ a— {� First
Last
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Owner's Address Owner's E-mail Address
City � fo }�1,>�.-.I/ �,, % State I C/A —Zip I � Telephone I rk' I
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APPLICANT'S NAME Last �� First
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Applicant's E-mail Address
Appl cant's Address+
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City State Zip Telephone q f 34_lVo
ARCHITECT/DErSIIGGN\ERK'S NAME Last —yam
Vp LW U'1 First,- LI Lic. No C�
Architect/Designer's Addres%ss Architect/Designer's E-mail Address
City 1 (G✓ (J State Zip Zip 5 Telephone��,
ENGINEER'S NAME Last First Lic. No
Engineer's Address Engineer's E-mail Address
City State F—_---7; Zip I� TelephoneF_
';ONTRACTOR'S NAME/COMPANY Lic. No. F_ Class n
ntractor's Address Contractor's E-mail Address
State F77 Zip I I TelephoneF_
' P/C FEE $ FIRE P/C FEE $ PERMIT NO.
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P/C FEE $
PLANNING P/C FEE $
PLAN CHECK NO. %}
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NMECH P/C FEE $
PLAN CHECK FEE $
-NT # TOTAL FEES PAID $