HomeMy WebLinkAboutX2012-2435 - Permit ApplicationX20) z13S
DEForm„x ;; Worksheet for Building Combo Permit Application JUN ?00 Shegelj
rl Comm Residential City of Newport Beach - Building Division M 5 g
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
I✓euildin g F_ Grading F-Drainage r-, Elec (j Mech F Plum Cuya CutF' Cu Yd Fill v
Project Address (Not mailing address) Floor Suite No
of
Description of Work
Use
# Storiesn # Units (if Res)
/
Valuation$ q
Material/Labor /�jUG
New/Add SF Remodel SF Garage/New/Add ��
OWNER'S NAME Last �� First J
Owner's Address Owner's E-mail Address
___ _- / 7-- 0Ir --- -- -- --- -- - -
City I VVt%.LA .( v g!- PC-G'1 State 54 Zip [ �S1/t(�ll _ Telephone Cv ,_I,-660/0 -6w_7
_
APPLICANT'S NAME Last First
Applicant's Address Applicantes Address -
7E,.-mail
.SGo+ !W d7 KvP✓t r'e G.n--F7 " ,$"vn. n2 �SGIIo✓', t-4L �1. ''
City Gv'vi(U /' _-----.._ --__� State Zip _ QP;` Telephone 75�" �lJ"_�
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. F,
Architect/Designer's Address Architect/Designer's E-mail Address
Z� it
City State �I'i Zip r Telephone �j r O 3%
ENGINEER'SNAME Last FFirst Lic. No.
Engineer's Address `Engineer's E-mail Address
City State —'�i Zi Telephone 97-So -3
CONTRACTOR'S NAME/COMPANY Lic. No. �— �c Class
Contractor's Address Contractor's E-mail Address
------------
City h r - �,z//Gi/ ,�' State �l-j- Zip S� Telephone �7- t%�
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO. Z
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO. f 1-7 Z' 7,01 Z
ELEC/PLUM/MECH P/C FEES PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $
J