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HomeMy WebLinkAboutX2021-0176 - Permit Applicationp worksheet for Building Combo Permit App5Cat1on r City of Newpw Beach - Building Division Comm'I Residential i, in=- of AM rrw Grru r=FF N IF AT TIMP: (-)F SI JRMITTAL 'KIBuilding [I Grading F]Dralnage Elec ) IMach Plum CuvdCut� —J Cu Yd Fill ] Prajact Address (Nest mal iing address.) Floor Floor Suite No PP Descriptian of Work /'����// Use �I (DIJ' L fd�lrL 0 G i/I NEVI/ # Stories) s '( # Units (it Res)LI Valuation Nevv/AddSF_____l Remodel SF Z are dc[7 Material/Labor V OWNER`S NAME LastFl2vm)i First Owner's Address owner's E-mail Address City ' �/V I/ _ --I State Zip Telephone �U APPLiCANT'S NAME Last —� First Applicant's Address I Applicant`s E -mall Address City � � ��/ � State ZIP )/�� Telephone ��„ ARCHfTECTfDESIGNEIt'S NAM[:. Last —J First tiL — LIc. No. G ArchitectfDeslgner's Address Archltect/Deslgnet's E-mail Address p Lr, K,- City State /� j ZIPME Telephone ENGINEER'S NAME Last[ First�� � Lia No.E___�] Engineer's Address Engineer's E-mail Address city _ State Zip �� Telaphon®[� COKITRACTORR''SSNAME/COMPhIVY �, LIc, No. Class ) Gohtre t�r's �ddke s 1 \ Contractor's E-mail Address--F�--F��—�— city \/6�V��---� State LCR -1 ZIP I Telephone ENERGY PIC FEE $ GRAD114G PIC FEE $ ELEC/PLUPA/MECH PIC FEE $ FIRE P/C FEE $ PERMIT NG./i A — 10-710 PLANNING PIC FEE $ PLAN CHECK NO. Oct Q 7W Z 6 — ( PLAN CHECK FEE $