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HomeMy WebLinkAboutX2009-0420 - Permit Applicationnobi - oq2 Worksheet for Building Combo Permit Application City of Newport Beach - Building Departm(:n:t please print 3 copies, IJQ - 5 uilding r- Grading [-Drainage ec ech 2!�n 1 1 E14 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 Q3- 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