HomeMy WebLinkAboutX2012-2172 - Permit Application'4I Worksheet for Building Combo Permit Application/ 361 014 mgxyt
Comm I Residential City of Newport Beach - Building Division ` g
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL ��' \�JG�
rl,Building ("Grading
rDrainage ['Flee Mech F-, Plum CuYdCut CuYdFill v
Project Address (Not mailing address) Floor Suite No
30 FJLCJ NLa.✓Pb�l i'ic ✓O, �y32G ku/5/S.c o C Iz Ley
Description of Work
Use
# Stories # Units (if Res)
Valuation $ O-e)
Material/Labor
New/Add SFF
Remodel SIF Garage/New/Add F
OWNER'S NAME
Last I��16'O' k%� .�L _ First
Owner's Address
Owner's E-mail Address
L;zyN /J /hz4�7r/rv� Dz.1�0?? -- �NisrA_ _ L rlbYr�rfiri. cc,6�
City G/}CTUNA 1-trv.._S
_ State CA Zip �J•ZG'� ''✓', Telephone -7iq{) 605 5;;_q!; ',
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City
j State -� Zip Telephone -..
ARCHITECT/DESIGNER'S NAME Last ', First F Lie. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �— _ _._
_ State F � Zip F_,..I Telephones,.,
ENGINEER'S NAME
Last F First Lic, No F
Engineer's Address
Engineer's E-mail Address
-City
State r Zip ��� TelephoneF�'',
CONTRACTOR'S NAME/COMPANY Lic. No. O n Class
�Y�r!-CTL1c,rfrrN(•r....... -_---- ------I J-JS__:
Contractor's Address
Contractor's E-mail Address
�'12S Rc�SE' Ste,
_.: hF�fr.tcn.'f' $66Gr A-oL,�crvi+n
City 13�1-Lrr,�weYL State C'A Zip cjo )O(n -.... Telephone 562r�'�(,
ENERGY P/C FEE $
FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $
PLANNING P/C FEE $ PLAN CHECK NO. \1
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $