HomeMy WebLinkAboutX2012-1517 - Permit Application�0
E Pnnt For r( i;,.,i Worksheet for Building Combo Permit Application
F Comm] F' Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
F-Building ', Grading j-:Drainage I-,Elec ('_ Mech
j-Plum CuYdCutF cuYdFill F
Project Address (Not mailing address)
Floor Suite No
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Description of Work
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#Stories #Units (if Res) ;
New/Add SF� Remodel SFF'' Garage/New/Add �
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Valuation $
Material/Labor I?,J5r7
OWNER'S NAME Last Y First
Owner's Address
Owner's E-mail Address
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City I rV�ll C�^i'�° State �f�....
Zip - Telephone g4;j._7�e{-141().
APPLICANT'S NAME Last First /
Applicant's Address
Applicant's. E-mail Address
City State
Zip �L�B Telephone Zp (.-r"P11—JI&O
ARCHITECT/DESIGNER'S NAME Last
First F Lic. No. r
Architect/Designer's Address
Architect/Designer's E-mail Address
City r State
ZiPF—i Telephone���',,
ENGINEER'S NAME Last
First F Lic. No.
Engineer's Address
Engineer's E-mail Address
City _ State
Zip Telephone��
CONTRACTOR'S NAME/COMPANY
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Lic. No. 5H2�J� Class
Address
Contractor's E -mail Address
Contractor's
City f.«Ine.iaw--------._---- -. State L74 --.-..
Zip ---a2_S'dZ.--.�I .Telephone 7( _.C(`�9-11.(40
ENERGY P/C FEE $ FIRE P/C FEE $
PERMIT NO. ! Z'Griy�'
GRADING P/C FEE $ PLANNING P/C FEE $
PLAN CHECK NO. `-2
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $