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Worksheet for Building Combo Permit Application
City of Newport Beach - Building Depa bu"URCES D
HARBOR RE"'
Building F—� Grading F'Drainage Elec
O�NEWPORT B_ f J_
1 - Project Address (Not mailing address)
Tenant Name(if Applicable)
z. uescription ot Work
,�.,Jsi House SF Demo House SF Add/Recciistruct House SF
zxis� Gar SF Demo Garage SF Add/Reconstruct Garage SF
F F F
TOTAL HOUSE SIF
..... . .... . . .......
# Units (if Resideraial)
Use
�7
Valuation $
Stories
e vv Ad
Alter
Denno
Cu Yd Cut
TOTAL
GARAGE SF
Cu Yd Fill
Check Appropriate Box,for Appiicant
3. Owner's Name
- - - ---------
Last 1
First
Owner's Address
Owner's E-mail Address
State
7
�!p Telephonei
4. Architect/Designer's
Name
Last
First F
Lic. No.
ArchitecUlDesigner's Address
Architect/Designer's E-mail Address
State Zip I Telephonei
Engineer's Name Last First 11_��
�_41 Lic. No.
r_jjr�:�Ie r's Address
4,:.� r_ngineer's E-mail Address
>
State
zip F Telephon
6. Contracfor's Name Last First
Lic. No�. L class
Cor�,ractcr's Address C—lontractor's E-mail Address
7�1
2:1 p
Telephone 7
State
OFFICE USE ONLY ENERGY P/C FEE $ PERMIT NO.
GRADING P/C FEE $
PLAIN CHECK NO.
717 ELEC/MECH/PLUM P/C
8/07 PLAN CHECK FEE $