HomeMy WebLinkAboutX2012-1323 - Permit ApplicationX2b1z-i3��
..,Pratw Worksheet for Building Combo Permit Application , i1
ji Comm Residential
City of Newport Beach - Building Division i Simi ur
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL IM
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Project Address (Not mailing address) Floor Suite No
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Description of Work
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# Stories (# Units if Res)
Valuation $®®
Material/Labor
New/Add SFr O --1 Remodel SF[—i Garage/New/Add —_ j
OWNER'S NAME Last rCJ01- �Cz1. J — First M�
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Owner's Address Owner's E-mail Address
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City ('j�rLo"A ov4,_ "me- State I " I Zip `7Z.G25 Telephone--------------
APPLICANT'S NAME Last h-�iOl`g/Z(.Yli' I First ��(Z.y✓
Applicant's Address Applicant's E-mail Address
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City awl t 1 p- State l� �j j Telephone � . 6 R--9 Z.77 Zip
ARCHITECT/DESIGNER'S NAME Last rl-bl..iFC'>G- First �mZJz,Y Lic. No.
Archit ct/Designer' ddress Architect/Designer's E-mail Address
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City rIA.T�S� CCTV I IV A State �� Zip 1"7 °I 1 i Telephone i& 4 Vje-'uZ7 7
ENGINEER'S NAME Last r First Lic, No,F-
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Engineer's Address I/' Engineer's E-mail Address
City -._ -. State Zip 1:7777 Telephoner
CONTRACTOR'S NAME/COMPANY `%j � 4 G rZ,�5V t I hJ C,, Lic. No. �1.25615_ Classy ]
Contractor's Address Contractor's E-mail Address
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City COVJI tJ &- . _._ _ C{a Zi p �i )� 1 Telephone qL��.' � __-_ I C,5
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO.
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $