HomeMy WebLinkAboutX2009-0420 - Permit Applicationnobi - oq2
Worksheet for Building Combo Permit Application
City of Newport Beach - Building Departm(:n:t
please print 3 copies,
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Project Address (Ncr(mailing address)
#40r At/\
Name(if Applicable)[ OW M L
2. Descrintinn -f w�
-r
0 �/ln-nr , t-P J o
Floor Suite No
F -77 [777
# Units (if Residential)
Valuation
Exist House SF Demo House SF —Add/Reconstruct F56s4
Exist Gar SF Demo Garage SF 1 Add/Reconstruct Garage SIP # 5 ies
F
HOUSE SIF
F— New r—.. Add Alter [—Demo
)TAL GAR�Gt br
L.
Cu Yd Fill
hecAppropriate Box for Applicai,t
.3. Owner's Name Last
7"
First
Owner's Address
Owner's E-mail Address
L4 0
C) 4 610 1 ce
City
State 661
Zip Telephone
J-� 4. Architect/Designer's Name
Last G IraFirstF Lic. No.
Architect/Designer's Address
A r c h i t a ctIDesigner's E-mail Address
..........
�7
Mot C_
City
State
F27
Zip
6 Telephonel 2(
0 -
1C-
F-9 5. Engineer's Name Last F�����
First 7� Lic. No.
Engineers Address
Engineer's E-mail Address
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4—
, / i Pec
F/ n (cw �,Tzq e;eot cl�� " X .. ... .. ....
City
State
F�7
Zip Tel e ephon
R24 1,07 t7l772,7ZD
6. Contractor's Name Last First Lic. No. T Class ..........
T1 74
Contractor's Address Contractors E-mail Addreps
city 7 State Zip CZ Telephone
.. .... .. ... .............. 11-1-11, 6,�� 1 - -0 ?�
OFFICE USE ONLY ENERGY P/C FEE $ 2-M -m PERMIT NO. 11PA -
GRADING P/C FEE $ PLAN CHECK NO. 0 3 N-,
Rev 1178107 ELEC/MECH/PLUM P/C PLAN CHECK FEE $ 1 2-ag.A3