HomeMy WebLinkAboutM2012-0035Pr�ntt=orm Worksheet for Building Combo Permit Application
Comm'I Residential City of Newport Beach - BuildingDLc ] ��� ®S�� 5�
NOTE: PLAN CHECK FEE DUE AT TIME V Fra
i Building r- Grading ("®Drainage r Elec Mech
j Plum
Project Addrerss Not. mailing address)
Suite No
FbDb W WD 5U.
Description of Work
Used
# Storied # Units (if Res)i
Valuation $
Material/Labor
New/Add SF Remodel SF Gara a/New/Adds
g
-j OWNER'S NAME Last /j �r First'
" `
Owner's Address
Owner's E-mail Address
jiJacquelyn.chung@sbcglobal.net
City Newport Beach State ;Califf fornix
Zip Telephone 1949 631.3121
APPLICANT'S NAME Last ;Swift
_ First Oete
Applicant's Address
Applicant's E-mail Address
12027 Placentia Avenue
Jacquelyn.chung@sbcglobal.net
City jiCosta Mesa State California
Zip X92627 Telephone 1949.631.3121
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
1
City State
Zip iTelephones
ENGINEER'S NAME Last Bazley
First 'Tim Lic. No. 50019
Engineer's Address
Engineer's E-mail Address
2500 Via Cabrillo Marina Unit 200
sJacquelyn.chung@sbcglobal.net
City San Pedro State !California
Zip F90731 Telephone 1949.631.3121
CONTRACTOR'S NAME/COMPANY ISwift Slip Dock and Pier Builders Lic. No. ,797052 Class 1A
Contractor's Address
Contractor's E-mail Address
2027 Placentia Avenue
'lJacquelyn.chung@sbcglobal.net
City Costa Mesa State CalitFyV fornia
Zip 192627 Telephone= 9 631.3121
ENERGY P/C FEE $ FIRE P/C FEE $
PERMIT NO.
GRADING P/C FEE $ PLANNING P/C FEE $
PLAN CHECK NO. l 0 1-- 12,
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $
CITY OF NEWPORT BCRCH
CITY OF
NEWPORT BERCH
BEST lF'PERBRY
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VICI ITY MRP easT
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ELEVATIONS BASED ON MEAN
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K: --ming HARBOR RESOURCES DIV.
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rot Ig
and side rail
Replace drYt or' on pier
Replace rotten p tees screws
k using sta
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IAPPI.ICANT'S M�p�N� � �y I JOB ADDRI M, 66j \414SDUG�� I D 15 2012
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IAPPI.ICANT'S M�p�N� � �y I JOB ADDRI M, 66j \414SDUG�� I D 15 2012
Worksheet for Building/Fire g /Fire Permit Ap lic_ation W�Re
Print Form_ � t- �
Please print 3 copies City of Newport Beaci
d � RLE Rl u' li
Building Department CUT OF NEE -V E Oo
I. Project Address (Not mailing address)
First'' - A/'t
Floor Suite No
r —
City .. State
Zip? Ce�j Telephone'
Legal Description Lot Blockl-
Tract',!
# Units
2. Description of Work
zipTelephone[
� p [�
Use !Moor Boat
First i, Lic. No.�---�
Engineers Address
Engineers E-mail Address
# Stories
Tenant Name if Commercial
City State }
Valuation $
F— 6. Contractor's Name Last Swift Slip _
First Lic. No.797052 Class �'A
1'
j— New (— Add 1- Alter F Demo X mq n 7—
City I Costa Mesa State CA
Scl Ft (new/add/extended)
Check Appropriate Box for Applicant/Notification Information
f` 3. Owner's Name Last
f T ►
First'' - A/'t
Owner's Address /
o V
Owner's E-mail Address
City .. State
Zip? Ce�j Telephone'
4. Architoct/Designer's Name Last . First r---- Lic. No. F_
Architect/Designers Address
Architect/Designer's E-mail Address
City State
zipTelephone[
� p [�
j 5. Engineer's Name Last'
First i, Lic. No.�---�
Engineers Address
Engineers E-mail Address
f
City State }
ZipTelephoncl _
F— 6. Contractor's Name Last Swift Slip _
First Lic. No.797052 Class �'A
Contractors Address
12027 Placentia Ave
Contractors E-mail Address
�!bhswiftslip@sbcglobal.net
City I Costa Mesa State CA
Zi;; i 9262r 7—� Telephone 949-631-3121
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION.
PLAN CHECK NO.
PLAN CHECK FEE $
OCCUPANCY- GROUP
PLAN CHECK ENG.
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