HomeMy WebLinkAboutX2012-1640 - Permit ApplicationF__I Comm'I f— Residential
Worksheet for Building Combo Permit Application
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) Floor Suite No
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Description of Work
Use
# StoriesF # Units (if Res)
Valuation $
New/Add SF I_I Remodel SF Garage/New/Add
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Material/Labor
OWNER'S NAME Last P 7 3a t_ First /
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last ul/,+&IAA First
Applicant'sAddares�s'f Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last( First _
I — I F_ Lic, No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State ! J Zip r j Telephone
ENGINEER'S NAME Last First Lic. No
Engineer's Address Engineer's E-mail Address
City - State Zip Telephone��i
CONTRACTOR'S NAME/COMPANY / nes Lic. No. ""I wo Class
Contractor's Address Contractor's E-mail Address
City ` a, idiLg State ( Zip f a 1 Telepho e
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK N0._bAIf
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $
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