HomeMy WebLinkAboutX2012-2463 - Permit ApplicationPrint Fort . ;i 0 s na t
Comm'I FResidential
Worksheet for Building mbo Pe rmit Ap lic ion.
City of Newport Beach -Building Division � �d _Z� Circle`��
NOTE: PLAN CHECK FEE DUE AT TIME OF SLIEWTTAL \ oa
4Building f—Grading
)--Drainage Elec F1 Mech F, Plum Cu vd Cut — Cu Yd Fill
Project Addres/s� (Not mailing address) Floor Suite No
l �E2 l.L 1Z 4) /—
-- I _
Description of Work
M DA Oct r
t j
Use v
f'o��'t
cc��-- YYYYYY,,,,,,-----������
# StoriesFT/# Units (if Res)
3an,_cQrcu,C
Valuation $ Material/Labor 2-
0 t0
New/AddSF� !
Remodel SF� Garage/New/Add ��
OWNER'S NAME Last hkb�J B( HJ .S -- --' First—DtJ--- ---'
Owner's Address
Owner's E-mail Address
City
State ZiP r b_tU Telephone)
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City °_. _fir .. �jLYI `—_� State _.i,/V Zip ---.1 � '_�. Telephone �l`t..32(" ((26=
ARCHITECT/DESIGNER'S NAME Last F First F � Lic. No. F__�
Architect/Designer's Address
Architect/Designer's E-mail Address
City �. -.
_ ': State F _— _ Zip F Telephone _ J
ENGINEER'S NAME
Last F First Lic. No F
Engineer's Address
Engineer's E-mail Address
City
J State Zip Telephoned
CONTRACTOR'S NAME/COMPANY I �n Lic. No.
'.tlUicclS S�(7YDa( Class)
Contractor's Address
- Contractor's E-mail Address
City --
Telephone
State I v t^C , Zip ���ple6 jqj �5 4, i
ENERGY P/C FEE $
FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $
PLANNING P/C FEE $ PLAN CHECK NO. 1 +40 ilk 1 ,
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $