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Worksheet for Building Combo Permit Application
City of Newport Beach - Building Department
';Building 17 Grading F"Drainage Elec r Mech�,
1. Project Address (Not mailing address)
Tenant Name(if Applicable) I
r
2. Description of Work
First
First
......................................................_............................._........
Owner's Address
.................... ................................................. ...................._......................._.......................
Owner's E-mail Address
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..... .... .............
Use
City ,/� jj�%� StateR�
..
Zip Q� Telephone
............................................. ..............
4. Architect/Designer's Name
LastF777777777
..............................................
Extg Building SFJ
..................... . ...........
Demo Building SF Add/Reconstruct Bldg SF
Architect/Designer's Address
Valuation $
..
Extg Gar sf
......_..................
Arch itect/Designer's E-mail Address
Demo Garage sf
Add/Reconstruct Garage sf
City
State
r��
# Stories €
Zip Telephone;
New Add
Alter
TOTAL BLDG SF
F7.Demc,
..........
Cu Yd Cut
Engineer's E-mail Address
A 9
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TOTAL GARAGE SF
Cu Yd Fill
3. Owner's -Name Last
First
First
......................................................_............................._........
Owner's Address
.................... ................................................. ...................._......................._.......................
Owner's E-mail Address
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..... .... .............
City ,/� jj�%� StateR�
Zip Q� Telephone
............................................. ..............
4. Architect/Designer's Name
LastF777777777
First tic. No.
Architect/Designer's Address
......_..................
Arch itect/Designer's E-mail Address
City
State
Zip Telephone;
5. Engineer's Name Last
First 14��i Lic. . No. c7C�f� i
Engineer's Address
Engineer's E-mail Address
A 9
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City € �r�� z�/
s........................, ..... ._....
State
.........
6
........ ........
..
Tele ..
Zip�� Telephone
.... p .........7 G -(
OFFICE USE ONLY ENERGY P/C FEE $ PERMIT NO.
GRADING P/C FEE $
FIRE P/C FEE $
PLAN CHECK NO. 11 "' 2—o V5
L Rev4/16/09 ELEC/MECH/PLUM P/C FEE $ PLAN CHECK FEE $
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