HomeMy WebLinkAboutE2019-0191 - Permit Applicationnt Form Worksheet for Electrical/Mechanical/ Plumbing Application
City of Newport Beach
Building Division L} '$�,�V-��(,�
9<,LpPN P
jj1]P�r7o�ject Address (Not mailing address) Building Permit No. 1 1,{,�1
t"" ` t • `I[r•7".7, 1 I + �i Y FTdor r Suite ��
i- 2. Owner's Name Last
First
Owner's Street Address
f'� •�"'�
City I-
State F_
Zip F_
Telephone I
Owner's E-mail Address
r 3. Applicant's Name Last
First
Applicant's Street Address
City IftAill
State F
Zip Fomlidlw
Telephone 11+-_14uvi O3
Applicant's E-mail Address
F_ 4. Contractor's Name Last
State Lic # 5 ��
{ First
Contractor's Street Address
City
State F_
Zip F_
Telephone
Mechanical
Furnace Quantity
up to 100,000 btu:r—
over 100,000 btu:r—
wall/floor heaters:F-
Heat Pumps/Package Units
up to 100,000 btu:F—
up to 1,000,000 btu:F-
up to 1, 750,000 btu:F-
> 1, 750,000 btu:F-
Boilers/Compressors
up to 3 HP:r-
3 HP-15 HP:F
15 HP-30 HP[
30 HP-50 HP:1_-
>50 HP:FW
Air Handling Units
up to 10,000 CFM:F_
> 10,000 CFM:F-
VAV Box:F-
Repair/Alter/Add HVAC
N umber of ZonesF-
Ventilation
Bathroom Fan:F—
Exhaust Fan:: -
Attic Exhaust:F-
Residential Hood:F—
Commercial Hood:[ --
Metal Fireplace:[ --
Gas Line:F-
Fire Dampers:F-
Contractor's E-mail Address
Business Lic # F-
Electrical Plumbing
Newconstruction Quantity Bathroom Quantity Quantity
1 & 2 Family S.F:F_
Multi Family S.F:F-
Receptacle, Switch Lighting Outlets
Total Outlets:�u
Lighting Fixtures
Total Fixtures:F_
Total Low Voltage:F
Separate Circuitl
Motors/Transformers
0-1 HP or KVA:F_
1-10 HP or KVA:F_
10-50 HPor KVA:F-
50-100 HPor KVA:F_
Over 100 HP or KVA:F_
Signs
One branch circuitF_
Add'I branch circuit:F-
Service
0-600V not over 200A:F
0-600V & over 200A:F-
over 600V:F-
Temp PP/Piggy Back:r
Sub Panel:FV-
MA Othenr-
-ok; lAiwl
Water closet (toilet):
Bidet:r-
Urinal:F_
Bath Tub:F—
Shower stall:F—
Lavatory (basin):r—
Hydro-massage tub:[
Kitchen
Kitchen sink:
Garbage Disposal:F-
Bar sink
Vegetable sink:F-
Dishwasher—
Laundry/washing trap:
Ice maker:r_
Floorsink:F_
Miscellaneous
Floor drain:F
Water piping:F_
Water soRener:F-
X) Water heater:F-
¢1 Lavatory (basin):F-
Gas sys up to 4 outlets:F_
Gas sys # of outlets over 4:F—
Backf ow device up to 2".F—
Backflow device over Y':,---
Regulators:F_
Lawn Sprinkler System:F—
Roof drains:F-
Hose bibb:F_
Drinking fountain:r-
Grease trap:
Grease interceptor:[
P-trap:
Sewer
New sewer
Sewer alter/repair:F-
Sewer abandonment:r—
tot I
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