HomeMy WebLinkAboutX2011-1956 - Permit Applicationr Comm'I
1641-2011 5 t
Worksheet for Building Combo Permit Application
n Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
r8uilding r Grading rDrainage lX Elec Z Mech r Plum Cu Yd Cut
Project Address (Not mailing address)
Cu Yd Fill
Floor
Suite No
.. 0 - Y'f "tt"-i
bele ^
?!w{ . _ _•�l.1/6'[ )
Basement
I
-._...__..__,.._
Description of Work
Remove abandoned stand-alone Central PlantUse
equipment with chillers, cooling tower, filter and
'
1..----.:-.. .;
water treatment system. oumos. accessories: electrical and controls.
ien en Meth plug
# Stories)
#Units (If Res)
Valuation $
II/
New/Add SFI
Remodel SFI861
Garage/New/Add
Material/Labor
U 0
OWNER'S NAME Last
Owner's Address
'Hoag Memorial Hospital Presbytti First!
Owner's E-mail
Address
Ione Hoag Drive
Igregg.zoll@hoag.org
City
'Newport Beach
State
ICA . Zip
92658-6100
Telephone
949-764-4468
APPLICANTS NAME Last
Applicant's Address
Neal
Applicants
First
'Michael
E-mail Address
15670 Oberlin Drive Imichael.neal@exp.com
Ci b I
i
San Die o State
9 i
CA
�! Zip'92121
Telephone1858-597-0555
ARCHITECT/DESIGNER'S
Architect/Designers
NAME Last
Address
IN/A
. First
Architect/Designer's
I
E-mail Address
, Lic.
No. I
City'
State
Zip'
Telephone)
ENGINEER'S
Engineer's
NAME Last
Address
ITrzepacz
First
Engineer's
IMichael
E-mail Address
Lic.
No.IM33288
I451
Montgomery, 3rd Floor
Imichael.trzepacz@exp.com
City
ISan Francisco ' State
[CA Zip
194104 Telephone1415
362-5025
CONTRACTOR'S NAME/COMPANY
Contractors Address
INOt I e ��
Y
� �, c2-r�y Lic.
Contractor's E-mail Address
No.
et �j47f
5
Class
170064. Pr Ritl 5T s./I'ib 300
Iat(es le) '✓es tax ro..a
ovl.tAa.-.
City
LNEYt oir.....__.P6 l __---. ` State
. ...eh...._
Zip
.....93-660 , TelephonelClirl)zso
1
o06a
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO. `j/S',lZ0lI
[ 95f 0
1 /`SI®
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO.
1649 --20i1
ELEC/PLUM/MECH P/C FEE $ e),b • 34- All; p 4 9144- - Z5 PLAN CHECK FEE $ (A?qq� BSJ I L--�`
DEVELOPMENT# r% - 0159 TOTAL FEES PAID$ IG' a3
S5)
CITY OF NEWPORT BEACH