HomeMy WebLinkAboutX2012-3162 - Permit Applicationw, PrnG�orm' ''� Worksheet for Building Combo Permit Application
F7 Coni F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
X2012- 3iE2.
410 Tri 5 Ave
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k_Min Grading
Drainage F_1 Mech Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailingtN1PeecS!S) Floor Suite No
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Description of Work
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Valuation $
Material/Lab�
New/Add SF � !
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Remodel SF Garage/New/Add
OWNER'S NAME
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Last First
Owner's Address
Ow ner's E-mail Address •
City ----_ -_____.
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.._- State r.__.— Zip Telephonec 51515 Jim
PLICANT'SNAME
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Last First �C L.
Applicant's Address
Applicant's E-mail Address
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City S?IDj , A tj
_ --- -� State C!Ik--- � Zip -q.. � Telephone WO 0.2_gP jb'"Vj
ARCHITECT/DESIGNER'S NAME Last (J�f First r-- F
� Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �— zip Telephone,
ENGINEER'S NAME
Last First F Lic. No.F�
Engineer's Address
Engineer's E-mail Address
City
State F Zip Telephone
CONTRACTOR'S NAME/COMPANY �- Lic. No.� OL 1 Class CL) I4
--'-'-- -
Contractor's Address
Contractor's E-mail Address
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City ���.t'l 1 '{`1 A - State Zip q�� Telephone (P5)._2tVGi,3&--W,1
ENERGY P/C FEE $
FIRE P/C FEE $ PERMIT NO. 261 Q —
GRADING P/C FEE $
PLANNING P/C FEE $ PLAN CHECK NO.F05� •��
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $
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