HomeMy WebLinkAboutX2012-1578 - Permit ApplicationComm'I [ Residential
X912-1575(
Worksheet for Building Combo Permit Application
City of Newport Beach - Building Division 7928 oumvI hIM.
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
['Building F Grading F-Drainage F Elec F_',Mech Plum CuYdCut CuydFill F
Project Address (Not mailing address) Floor Suite No
Description of Work
Use
Stories `'�' # Units if Res)
I F—�
Valuation $
Material/Labor /
New/Add SF Remodel SF I— Garage/New/Add F
OWNER'S NAME 1 -
Last ----' First--p'cl��i .
Owner's Address - Owner's E-mail Address
City State �, Zip Telephone u j p i 6-2--A--3 -7 3
APPLICANT'S NAME Last [:7A � i First
Applicant's Address Applicant's E-mail Address
trja® 5I2f5'(zL IV®lZ�f'i -Wn23 i% It �-.S'S'�C,t6tS � `C*vv�
City �..�.,. �p421_, '�Gh� - I State I Zip _�.2%(e� Telephone -tl 4,.z-7�i---�`��7�
ARCHITECT/DESIGNER'S NAME Last TA �1t' First ltr M� Lic.No.
Architect/Designer's Address Architect/Designer's E-mail Address
City .- State-- Zip Telephone
ENGINEER'S NAME Last First Lic. No.
-�
Engineer's Address Engineer's E-mail Address
City State Zip W Telephoned
- -
CONTRACTOR'SNAME/COMPANY f-p J ilG' 34SS�cfA c�, Lic. No.'Class
Contractor's Address Contractor's E-mail Address
I'D
City State off.. _ Zip Q. Q Telephone��
Y
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 $
71