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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 °13 Uly •too