HomeMy WebLinkAboutX2012-2520 - Permit Applicationf- Comn; I FI Residential
Worksheet for Building Combo Permit Application
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
XZ0iz Z5.zW
700 Prornonmry
lift
brw
F-Building F_ Grading f—Drainage )"_'Elec F'i Mach Plum Cu yd Cut F_7 Cu Yd Fill v
Project Address (Not mailing address) Floor Suite No
ZOO ?2Dt`G9-;aW?-- vJr—
Description of Work I
Use
d-hLTCLVSI ,ram 6�162
# Stories # Units (if Res)[—
Valuation $
Material/Labor S
New/Add SF Remodel SF Garag a/New/Add
OWNER'S NAME Last First I # 04 '' m In,'
�
- Owner's Address . Owner's E-mail Address
1t9
C9,4
City . State (_ Cam_ Zip � _ TelephoneF
APPLICANT'S NAME Last i Uaj First �,( . _� AC,wl -
Applicant's Address Applicant's E-mail Address
City / State Zip 'l (� Telephone
ARCHITECT/DESIGNER'S NAME Last 1�11 i First Fj:�As N Lic. No
Architect/Designer's Address Arch itect/Designer's E-mail Address
City., s�.rlJMDO State �.. Zip qeF2.qg_; Telephoned ®,
ENGINEER'S NAME Last First i Lic. Not —
Engineer's Address Engineer's E-mail Address
City State �— Zip � TelephoneF_
CONTRACTOR'S NAME/COMPANY �` �k7N5QR�GpilG- Lic. No. lq[� -r�q'; Class
Contractor's Address Contractor's E-mail Address
lgJla_i rrr " 26mism�.,v-Icrit&l.
City SlI�I_ U��-y State Zip C�' g Telephone iUs77it•0'z
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO. ✓
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK N .
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $
no 01MR600041