HomeMy WebLinkAboutX2012-2134 - Permit ApplicationPrntF4Fm zrksheet for Building Combo Permit Application
] ;omm I F7 Residential City of Newport Beach - Building Division
�� NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
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Building 7- Grading (`-:Drainage KElec Mech X,Plum CuYdCut l 7� CuYdFill F_ r
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Project Address (Not mailing address) Floor Suite No
Description of Work
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# StoriesT # Units (if Res)
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Valuation $
Material/Labor �st �0
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New/Add SF Remodel SF I Garage/New/Add r—�i
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1 OWNER'S NAME Last -- UCSFvf?t''CTt�} First
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Address Owner's E-mail Address
((Owner's
City U l L`t fb(PlrJV^ �.P State .i Zip 9 �. v1 7 Telephone 1& ,6 r3;-_- .. 'r-f-
APPLICANTS NAME ' -
Last � � First
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Applicant's Address Applicant's E-mail
�Ajdddress
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City State Zip f Telephone q l,�
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ARCHITECT/DESIGNER'S NAME Last�,� tkp First) Lic. No.
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rArchitect/Designer's Address Architect/Designer's E-mail Address
City _.-... _...._..-- �State r Zip Telephone _..PAID .
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ENGINEER'S NAME Last First No.
Engineer's Address Engineer's E-mail Ad '"
City State F777 Zip F__ Telephoned
CONTRACTOR'S NAME/COMPANY Lie. No. Class',
Contractor's Address Contractor's E-mail Address
City State i Zip �� TelephoneF�
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 FEES PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PF;ID $
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