HomeMy WebLinkAboutM2009-0056Worksheet for Building Combo Permit
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City of Newport Beach - Building Depart OR RESOURC
Please print 3 copies
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("'Building F7 Grading r—F M uDrainage Elec ORI D
1. Project Address (Not mailing address)u i t�N o
Check Appropriate Box for Applicant
F-1 3. Owner's Name
LastFirst
'I
0,
..
fl -11944 /
....... . ....... ..... .... ..........
Owner's Address Owner's E-mail Address
. ........... :!.............
.............
...... ..... ............ ....................
y State zip ... ..............
Telephone
7"000
Cit
F -C ... .........
...................
F-, 4. Architect/Designer's Name LastI First
............ ............... ................... ......................................................
Architect/Designer's Address
F_
.............. ............. .......... .......... .............................................................. .................. ................ ....................
CitYF--7777777777777777 State
5. Engineer's Name Last
Engineer's Address
City
..................
State F77
Arch
Address
Telephone
........................
...............................
Lic. No.
First
Lic. No.
........... .................... .......... I ............ F
Engineer's E-mail Address
............
Zip
..... Telephone
........ ..... ..... ..................
6. Contractor's Name Last___ First
............... 54::::��
. . ............
Lic. No. Q ss
............
Contractor's Address - I Contractor's E-mail Address
................... ......................................................................
_-Z ............... .... .................................
City State -ip
........................... C Telephone
.................................. .................... .............
...................... F6
OFFICE USE ONLY ENERGY P/C FEE $
GRADING P/C FEE $
PERMIT NO.
PLAN CHECK NO.
Rev 1118107 ELEC/MECH/PLUM P/C PLAN CHECK FEE $