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IN Comm'I r Residential
Worksheet for Building Combo Permit Application
City of Newport Beach - Building Division o�4
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
F—Building F_Grading rDrainage F_Elec j—Mech
F—Plum Cu Yd Cut OF Cu Yd Fill10
Project Address (Not mailing address)
Floor suite No
1401 Newport Center Drive
t
Description of Work
Use
SITE IMPROVEMENTS, FOR THE LOCATION OF PROPOSED BOLLARDS
# Storiest #Units (if Res)
Valuation $
New/Add SFF_ Remodel SF 278 Garage/New/Add
150, 000
Material/Labor
OWNER'S NAME Last Woldenberg Flr the Company Retailoperations First Joe
Owner's Address
Owner's E-mail Address
401 Newport Center Or
jwoldenberg@irvinecompany.com
City Newport Beach State CA
Zip 92660 Telephone 949-720-3300
APPLICANT'S NAME Last Ostrom /STANTEC
First Brandon
Applicant's Address
Applicant's E-mail Address
38 Technology Dr. W., Suite 200
brandon.ostrom@stantec.com
City Irvine State CA
Zip 92618 Telephone 949-294-9074
ARCHITECT/DESIGNER'S NAME Last First— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F—
Zip F__ Telephoned
ENGINEER'S NAME Last STANTEC/Ostrom
First Brandon Lic. No.675S2
Engineer's Address
Engineer's E-mail Address
38 Technology Dr. W., Suite 200
brandon.ostrom@stantec.com
City Irvine State CA
Zip 92618 Telephone 949-294-9074
CONTRACTOR'S NAME/COMPANY T. B. D.
Lic No. �— Class
Contractor's Address
Contractor's E-mail Address
I
City State
Zip F_ Telephoned
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 $