HomeMy WebLinkAboutM2009-0011Worksheet for Building Combo Permit Application �Cwpo
City of Newport Beach - Building Depa-rtment
Please print 3 copies
c�QrRlu RESOURCES
/.Building F-. Grading F_ -..Drainage 7 Elec Me M
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1. Project Address (Not mailing address) %oy vr nc"KI DmA
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F7 3. Owner's Name
Last FF First
Owner's Address
Owner's E-mail Address
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City......... .......... ..............................
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State Zip Telephone
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Arch itect/Des igner's Name Last Firs Lic. No.
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Architect/Designer's* Address .11A/A T, . ....... ......................
Architect/Designer's E-mail Address
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city
State I Telepho
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5. Engineer's Name Last
. First
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City
F_ -A State
................. F
r-,6. Contractor's Name Lastl
Engineer's E-mail Address
Lic. No. F777
OFFICE USE ONLY ENE-RgY P/C FEE $ PE WRINO. J
GRADING P/C FEE $ PLAN,
Rev 111W07 ELEC/MECH/PLUM P/C
PLAN CHECK FEE $
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