HomeMy WebLinkAboutM2013-0018t 37�2�1
Worksheet for Building. Combo Permit Application
City of Newport Beach Building Di S
F Comm'I a, F Residential NOTE: PLAN CHECK FEE DUE AT TIME O B ,RESOURCES
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r—,,Building r— Grading r -`Drainage .F Elec r7 Mech F- Plum Cuvc .k
Project Address (Not mailing address) oor �I4Suite o
21PA 16LZ
Description of Work .
Use
01
Ko _i456�_ AM+
# StoriesF_ # Units (if {�
(J(J Res)[—
j—� Valuation $ O
New/Add SFF Remodel SF Garage/New/Add I Material/Labor
OWNER'S NAME Last \ First
Owner's Address Owner's E-mail Address
AID lxx� i, ' iJacquelyn.chung@sbcglobal.net
Ci Newport Beach State California
�' Zip OW Telephone 949.631.3121
APPLICANT'S NAME Last Swift First I Pete
Applicant's Address Applicant's E-mail Address
2027 Placentia Avenue Jacquelyn.chung@sbcglobal.net
City Costa Mesa .W�� State California Zip 92627 Telephone 949.631.3121
ARCHITECT/DESIGNER'S NAME Last First
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip Teiephonel
ENGINEER'S NAME Last Bazley FirstTim, Lic. No. 50019.
Engineer's Address Engineer's E-mail Address
2500 Via Cabrillo Marina Unit 200 Jacquelyn. chung@sbcglobal.net
city California. Zip 90731 Telephone j9�49�.`6313121
Ci San Pedro State
CONTRACTOR'S NAME/COMPANY ISwift Slip Dock and Pier. Builders Lic. No. 797052 Class
Contractor's Address Contractor's E-mail Address
2027 Placentia Avenue Jacquelyn.chung@sbcglobal.net
Ci Costa Mesa State California Zi 92627 Telephone 949.631.31
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING P/C' FEE ,$ . PLANNING P/C FEE $ PIAN CHECK NO,
ELEC/PLUM/MECH P/C FEE.$ PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $
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CITY OF
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ELEVATIONS BASED ON MEAN LOWER LOW WRTER.
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