HomeMy WebLinkAboutX2012-2892 - Permit ApplicationA
Print Form
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Worksheet for Building Combo Permit Application
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address)
Floor Suite No
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Description of Work
Use
#Stories #Units (if Res)
Valuatiorialn $ j
Mate/Labor) (J®
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New/AddSF1 Remodel SFF _�
Garage/New/Add
OWNER'S NAME Last yt,/Y ' Cit�.3
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Address
E-mail Address
�Owner's
�O"wner's
City i �%"✓�--• State �.+rl
! Zip
i Telephone"
APPLICANT'S NAME r,°--
Last ..� rn ji
. _. _.� First
Applicant's Address
Applicant's E-mail Address
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City'.._ _..'. State I�-✓'-
Zipeq�7>...! Telephone��lC/..()i"�C�Cy
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ARCHITECT/DESIGNER'S NAME Last i First �.__.___.
Lic. No. �`
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Architect/Designer's Address
Architect/Designer's E-mail Address
City._ _._ _ State
Zip � _._. Telepho �
ENGINEER'S NAME Last
( i NQU 2 �1��2
;First Lic. No. F
Engineer's Address
Engineer's E-mail Address
city _ _� State ��.-
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ZipI Telephoned
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CONTRACTOR'S NAME/COMPANY
ry t-s- j Lic. No..i i'Wt 7 Z Class
Contractor's Address
Contractors E-mail Address
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City,t,,,;d State FC
Zip � TelephoneSi'
ENERGY P/C FEE $ FIRE P/C FEE $
PERMIT NO. - '�,_.y �y 4',1✓
GRADING P/C FEE $ PLANNING P/C FEE $
PLAN CHECK NO. �'f7�,
ELEC/PLUMAIECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $