HomeMy WebLinkAboutM2007-0061Worksheet for Building Combo Permit" OUR
City of Newport Beach - Building Departm
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Please print 3 copies C17 OF NEWPORT
Grading -Drainage Elec Mech
,.Building F Pffn
1. Project Address (Not mailing address) titim No
................................
F .......................................... .. ..... . .. ......................... ......... .. ....... ............................................................................................... . ..................... ...........
# Units (if Residential)
Tenant Name(if Applicable)
2. Description of Work
Exist Gar SF Demo Garage SF
New Add Alter
Add/Reconstruct Garage SF
..............................................
TOTAL HOUSE SF
TOTAL GARAGE SIF
...........................................................
Use ME
Valuation$
# Stories 17
Cu Yd Cut 177
Cu Yd Fill F77
Lic. No.
[7- 4. Arch itect/Desig ner's Name Last First
I ... ... .... . .. .. ...... .
Engineers Address Engineer's E-mail Address
............................................ .................................. ...........................................................................................................
......... .......... .... .... .. . . ... . . . ......... .. ............... . ................ .. . . .......... ..... ...................
City State Zip Telephone
... . . .............. . .... ............ .... ........................................... .............................................................
OFFICE USE ONLY ENERGY PIC FEE $ PERMIT NO.
GRADING PIC FEE $ PLAN CHECK NO.
Rev 1118107 ELEC/MECH/PLUM PIC PLAN CHECK FEE $
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CAITY OF NEWPORT BEACH
HARD(DR PERMIT
'EcRMISSION IS HEREBY GRANTED TO CONSTRUCT AND
NIA�NTAIN THE FACILITY S40WN ON THE REVERSE HEREOF,
AT THE SITE INDICATED, SL16JECT TO THE PROVISIONS OF
THE HARBOR PERMIT POUCIES OF NEWPORT BEACH AND
ANY SPECIAL C8ZITION'S LiSTED HEREON. THIS PERMIT
'S N01 TRANSFERA811 WtTHOUT THE WRITTEN CONSENT OF
THE CITY HARBOR C.'60RDINIATOR OR CITY COUNCIL. THE
RIGHTS GIVEN UN'DER -,1-41S PERMIT ARE PER IVE ONLY
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7HIS ',lAv lf-O �-D Y T Cl COUNCI��
1;�.: ACDORDANCE WIT, THE UNI IPAL COpf.
ai'� 16i-:�R-8,,'YR-000RDlNAT0—R
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DATE
APPROVED BY: DATE
OCHD
ENGR
COUNC
IL F
PUBLIC WORKS F
DEPT.
ESCROW El
INSPECTION zr
0'�V'�K
El
SPECIAL CONDITIONS:
A DDRESS OF PROPOSED FACILITY PERMIT #
�4� 1 a
I TFI FPHO15F N6- I ECK NO. I DATE
APPLICATION IS HEREBY MADE FOR A HARBOR PERMIT TO
CONSTRUCTIREVISE A
AT THE ABOVE LOCATION IN ACCORDANCE WITH THE CITY OF
NEWPORT BEACH PERMIT POLICIES AND THE ATTACHEDPRAW!j4G
,--- 0 /- / Q /- 0
BY
DATED
DATE
SIGNATURE
CITY OF NEWPORT BEACH, CALIF.
COMPANY
WX FORM 68-1010
AMEt��
R RPFAt�-ITY:
'd:
PERMIT #
MAILING ADDRESS
TELEPHONE NO�
FEE/
CHECK NO.
DA: rE
V
0 ED BY:
DATE
ioot o ATTY RANSFER HARBO!VERMIT
f U t1A
SEL E R'S NAME(S)
BUYER'S NAME(S)
ENG
ABOVE NAMES TO BE TYPED,
COUNCIL, El
LIREOFBI�-M,
IRTOF SELL�R
SIGNATL-
PUBLIC W ORKS LJ
DEPT,
ROW
S�5NATIJRE OF SELLEY
16NATU RE OF. E#jYER
ANSPECTTIdN
S GNATURE OF, DINT OWNE
APP Til F�PRO
(DATE),
vC"ITY HARWR INSPECTOR
SPECIAL CONDITIONS: THIS PERMIT IS REVOCABLE BY THE CITY COUNCIL IN ACCORDANCE WITH TITLE
17 OR THE MUNICIPAL CODE
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CITY OF NEWPORT BEACH, CALIF. m 66-1013 R�.