HomeMy WebLinkAboutX2012-2597 - Permit ApplicationFrntForm,'^i Worksheet for Building Combo Permit AnnJic'&'b1
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h Comm I jij Residential City of Newport Beach - Building Division ®VJ
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) Floor Suite No
Description of Work
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# Stories�'I #Units (if Res)1
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Valuation $ �lp �-
Material/Labor a
New/Add SFF -,-- Remodel SF �(orz ' Garage/New/Add 7
OWNER'S NAME Last First
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Owner's Address Owner's E-mail Address
City � r �f, 1jjL_L State I P, Zip j TejephoneF_
APPLICANT'S NAME Last ��y� a First �] I-L
Applicant's Address Applicant's E-mail Address
City Rj'l ] `�54JiV. )�� J State Zip Telephone GT 49 e jrBCj...,.6cl
ARCHITECT/DESIGNER'S NAME Last Cott l First ft LL,,, Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City t. �j-],�}ae�, lP=' y _ State L Q" Zip �'Zlr;�) Telephone 4q..-
ENGINEER'S NAME Last N T First Lic. No
Engineer's Address Engineer's E-mail Address
City - State �� Zip (, Telephone
CONTRACTOR'S NAME/COMPANYt Est. Jqf_7'f1C�7jJ Lic. No. 1� Class �(
Contractor's Address Contractor's E-mail Address
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City ��'y'y ] �-] ,,x j7 7 —j State Zip 9?z;i 1.....-I Telephone ¢1qq-, t 884 qoq l`i
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO. , 0 --
ELEC/PLUM/MECH P/C FEE $ - PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $