HomeMy WebLinkAboutX2012-2196 - Permit ApplicationT ,OptWorksheet for Building Combo Permit Application
r—, Comm'l r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
X 2 0)2-2196
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F—Building F— Grading
F-Dramage f—Elec I' Mech j7 Plum Cu Yd CutI I CuYdFill
Project Address (Not mailing address) Floor Suite No
Description of Work
Use
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#Stories[7 #Units (if Res)[—,
Valuation
Material/Labor, C)
New/Add SF F
Remodel SF Garage/New/Add
OWNER'S NAME
Last First
Owner's Address
Owners E-mail Address
City
State Zip F Telephone
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address [10 -31-13
City
State Zip Telephone[
F
ARCHITECT/DESIGNER'S NAME Last L First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address al-3003o 50
City
State Zip Telephone[ --I
J I
ENGINEER'S NAME
Last First F Lie. No,F
Engineer's Address
Engineers E-mail Address
City
State Zip Telephonel
CONTRACTOR'S NAME/COMPANY [--
Lic. No, P�F07,�m i Class_C_—i/_ C
Contractor's Address
Contractor's E-mail Address
V0 Ali Z,
City
State Zip G? ti Telephone[
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 PAID $