HomeMy WebLinkAboutX2012-2727 - Permit ApplicationPrint Farm', U kworksheet for Building Combo Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
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JzZkuilding 'Grading Drainage Elec r7Mech 7 Plum CuvdCut CuYdRI F
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Project Address (Not mailing address)
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Floor Suite No
1
Description of Work
Use
# StoriesT # Units (if Res)F—
\ .. ,.
Valuation $
Material/Labor
New/Add SF Remodel SF�i
Garage/New/Add
OWNER'S NAME Last v(�j^�f�avl�y First
Owner's Address
Owner's E-mail Address
Tye
City �DLL7D✓ 1' 4 �'���.„ State l.�'�• Zip Vj......... Telephone
APPLICANT'S NAME Last
First r b l
Applicant's Address
Applicant's E-mail Address
2 l 7 -11 �r✓�c� t�
1rL--mr-,� c.>TL Q,> G�,xA
City rn a. Sca'a1.,.. V l `'q..-- State ��
Zip C�'j'Z(pnl.1 Telephone �'i4...5c611el.____. -
ARCHITECT/DESIGNER'S NAME Last First p�
ICJ _�.,�.,. Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
2 17� 1L�
City vYll 1 ,�13) �� State �—
Zip �270-1 Telephone 4el G. /JO�1q
ENGINEER'S NAME Last First a4co-LI Lic. No E;`; b4
r
Engineer's Address
Engineer's E-mail Address
120101 arm -I� v >r�7
��a LC� w w C,-- ..
City 1�.7"17�r.2.."jly�'� _- State �-
Zip '...--_.- TelephonePj(,..-.'1''0,�.,,�rZ��['j
CONTRACTOR'S NAME/COMPANY
Lic. No. 2' Class 13
Contractor's Address
Contractor's E-mail Address
City ls�iat�_ 1 ,�%j State ��
Zip °511,91 J Telephone q G�.��
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ENERGY P/C FEE $ FIRE P/C FEE $
PERMIT NO.
GRADING P/C FEE $ .PLANNING P/C FEE $
PLAN CHECK O.
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $