HomeMy WebLinkAboutM2009-0043Worksheet for Building Combo Permit Application
City of Newport Beach - Building Department
Please print 3 copies
F.Building F7 Grading f—..Drainage f—, Elec f`Mech F7 Plum
1. Project Address (Not mailing address)
"IR . .... ......... - . . ...... ...........
Tenant Name(if Applicable)
............................. ................... I ........... ............................... ........ ..........................
2. Description of Work
E . ........ . .....
..0
. ......... .. .............
Exist House SFF-Dze'House SF
Exist Gar SF Demo Garage SF 177
New F Add F..-. Alter F ....Demo
Check Appropriate Box for Applicant
3. Owner's Name Last First
.................................. ........... ..................................................
... . ...........................
SVC,
Use
Suite No
....................................................................
Valuation $
... .. ...... .. . .........
# Stories
Cu Yd Cut
Cu Yd Fill 177
Owner's Address Owners E-mail Address
I -AI
. ............. ................................................. ... ........... ...................... ..... ........................................................................
................. .................. ... .
.................................................
City State Zip
Telephone
.......... ...... ...... .................. ...................................... ............. I .................. 11 .......... .................................
............
F7, 4. Architect/Design0,,s Name Last First
Lic. No.
.......................................... .................................. ..... . ........................... .........................................
Architec 9signer'§ Address
Architect/Designers E-mail Address
J611IJ
............... ............ ........................................... t
.......... ............
......................... . . .............. . . ........
city State ZiPI '�11'�/'_�,-7i Telephonq 1,2
FUT . ......
.. .............
f7 5. Engineer's Name Last Firsf ic. No.
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......................................................................................................... ........... .... . ........... I ................................
Engineer's Address Engineer's E-mail Address
J . ..... .............................
t� ................
.......... I ..... ......... ..... ......
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City State Zip Telephone
................ ...........................................
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F ......... 7�ini Ir L ) % I ..... ........
OFF1g8LU&fg)Nffi ENERGY P/C rEE $
GRADING P/C FEE $
CITY OF NEWPORT BEACH
Rev 1118107 ELECAVIE-CrilrLUM P/C
PERMIT NO.
PLAN CHECK NO.
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