HomeMy WebLinkAboutM2007-0059Worksheet for Building Combo Permit Application
City of Newport Beach - Building Department
Please print 3 copies BOR RE . SOURCES
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1. Project Address (Not mailing address). n oor
14 1 A
Tenant Name(if Applicable) ry
(CIIZ&4
...... ............... ....... __ 11 ... ....... ........ ..... ... . . .......... ........... .... ........
2. DescriDtiQn of Work
Exist House SF I Demo House SF
Exist Gar SF Demo Garage SF F77
F-- New F-1 Add A I t e r
...... ...... .....
MAI k1f
Add/Reconstruct House SF
Add/Reconstruct Garage SF
L
TOTAL HOUSE SF
�OTAL GARAGE SF
'hecK Appropriate Box Tor Applicant
17 3. Owner's Name
Last First MA
............ ...... . ......... .......... ...........
Z
# Units (if Residential) F77
Use
...........................
Valuation $ 15-0,vo
. ..... . ...... . ............
. .. .... ...... . ....
# Stories
.......................
Cu Yd Cut
.............................
Cu Yd Fill
Owner's Address Owner's E-mail Address
........... Jv_
.............
........................................
City State zip Telephoner
......................................... .........................................................
Engineer's Name ast First Lic. No.
I ........................................................... .............................................. ............................................................. i
Engineers Addres Engineer's E-mail Address
......................... ... 0 .......... ....................... ...................... .. ....... .... . ......... .. ........................................ ....................
I ......................................................................... ..................... .................................................................................................
City State Telephone
.......... ...................... ............................ ......................................... F77 zip[-________,
Lic. No. a
F7
: ss
r7i, 6. Contractor's Name Last First
1 5 ............ P ir- ............................ ........... .. .............. ............ ....
Contractor's Address Contractor's E-mail Address
7 ............... ............................................................................................ . ......................................................
City State (,4--zi P Telephone
.............. .............................
.... ........................................
OFFICE USE ONLY ENERGY P/C FEE $ PERMIT NO.
GRADING P/C FEE $ PLAN CHECK NO.
Rev 1116107 ELEC/MECH/PLUM P/C PLAN CHECK FEE $
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7771�PROJECT AD DRESS (NOT MAILING ADDRESS) FLOOR ITE No.
L E -GAL DESCRIPTION No. UNITS
--LOT BLOCK TRACT
2. DESCRIPTION OF WORK R,,:, d� USE 90--r
#OF STORIES
00
VALUATION $1 70
NEW ADD ALTER DEMO Ej SQ FT
m 44m (NEW/ADDED/EXTG)
Check Appropriate Box for Applicant
F� 3. OWNER'S NAME k FIRSJ
1,41
OWNER'S ADD7S� 7—OWNER'S
E-MAIL ADDRESS
CITY STATE ZIP
zt__,�' 3( 67?402-
PHON� N.O.
//
F� 4. ARCH ITECT/DESIGNER'S NAME LAST FIRST
LIC. NO.
ARCH ITECT/DESIGNER'S ADDRESS
ARCH ITECT/DESIGN ER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
F-1 5. ENGINEER'S NAME LAST FIRST
STATE LIC. NO.
ENGINEER'S ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
F-1 6. CONTRACTOR'SNAlVIF-
BUSINESS LIC
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PTATE LIC.
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CONTRACTOR'S ADDRESP
CONTRACTOR'S E-MAIL ADDRESS
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OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
PLAN CHECK FEE $
OCCUPANCY- GROUP PLAN CHECK ENG.
rU[lllbA0lUy_dppll1Ull 01411—
NAME ADDRESS OF PROPOSED FACILITY PERMIT #
Ur,,p_A- g)l VIA J-11,0 souy -7 2,
MAILING ADDRESS TELEPHONE NO. -?/ C/ FEE CHECK NO. DATE
00
APPROVED BY: 9 EEVgoCLI *i LL.-SIDAA—AIL 1701-1 -1- APPLICATION IS HEREBY MADE FOR A HARBOR PERMIT TO
OCHD F—I CONSTRUCTIREVISE A
AT THE ABOVE LOCATION IN ACCORDANCE WITH THE CITY OF
ENGR/ F NEWPORT BEACH PERMIT POLICIES AND THE ATTACHED DRAWING
COUNCIL BY c' e-0 c- COMPANY
Pf4l�40_RkS DATED
DEPT. DATE
ESCROW El
INSPECTION SIGNATUR9 4
F1
SPECIAL CGPDITI
CITY OF NEWPORT BEACH, CALIF. WX FOR, 010
NAME ADDRESS OF PROPOSED FACILITY PERMIT #
*�te 1* ce I I t) 1,9 S c: -IV - I ' /' 7
MAILING ADDRESS TELEPHONE NO. FEE %rl CHECK NO. DATE
5�
21 'a
lel'wrl f—I J�
APPROVED BY: 'V �%DTTF APPLICATION IS HEREBY MADE FOR A HARBOR PERMIT TO
OCHD El CONSTRUCT/REVISE A
AT THE ABOVE LOCATION IN ACCORDANCE WITH THE CITY OF
ENGR/ El NEWPORT BEACH PERMIT POLICIES AND THE ATTACHED DRAWING
COUNC� -BY r#,c Doc k 40 COMPANY
..........
DATED
P"L ZOR,KS
DEPT.
ESCROW DATE
INSPECT16N SIGNATUR
El
'S P I ECIAL COPUTIONS)
CITY OF NEWPORT BEACH, CALIF. WX FOR_-_�iolo