HomeMy WebLinkAboutE2018-0753 - Permit ApplicationWorksheet for Electrical/Mechanical/ Plumbing Application �EW��
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City of Newport Beach Building Division ° a
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1. Project Address (Not mailing address) Building Permit No. g-a_0i 8.._ -7 5 S
Floor Suite
r; 2.Ownees Name Last First
Owner's Street Address
City F—. State F—�I Zip F
Telephone F Owner's E-mail Address
3. Applicant's Name Last -j First
A licant's Street Address
city State Zip
Telephone Applicant's E-mail Address
r 4. Contractor's Name Last First Sta _ 'c
Contractor's Street Address
City I State �� Zip
Telephone I Contractors E-mail Address Business Uc#
Mechanical
Furnace Quantity
up to 100,000 btu:
over 100,000 btu:—'
wall/Boor heaters:--
Heat Pumps/Package Units
up to 100,000 btu
up to 1,000,000 btu --
up to 1, 750,000 btuF—'
> 1, 750,000 btu
Boilers/Compressors
up to 3 HP
3 HP-15 HP f
15 HP-30 HPF-
30 HP-50 HP
>50 HP�--,
Air Handling Units
up to 10,000 CFM:F--
> 10,000 CFMF
VAV Box.—'
Repair/Alter/Add HVAC
Number of Zonesl—
Ventilation
Bathroom Fans-
ExhaustFanF—
Attic Exhaust:
Residential Hood
Commercial Hood'
Metal Fireplacef—
Gas Line
Fire Dampers: —
Electrical
New Construction Quantity
i & 2 Family S.F:F77
Multi Family S.F f —i
Receptacle, Switch Lighting Outlets
Total Outlets:
Lighting Fixtures
Total Fixtures;,
Total Low Voltage-,'
Separate Circuttf —',
Motors/Transformers
0-1 HP or KVA:r-
1-10 HP or KVA-f—:
10-50 HP or KVAf
50-100 HP or KVAF'
Over 100 HP or KVA:F
Signs
One branch circuit:—
Add'I branch circuitf----
Service
0-600V not over 200AF-
0-600V& over 200AF
over 600V:—
Temp PP/Piggy Back
Bathroom Quantity
Plumbing quantity
Water closet (toilet):-
Backilow device up to 2"FI
Bidet
Backnow device over 2"
Urinal::
Regulators:
Bath Tub:
Lawn Sprinkler System
Shower stall
Roof drains:1—
Lavatory(basin)F--
Hose bibb:F—
IGtchen
Hydro -massage tubF— Drinking fountain
Kitchen sink: --
Garbage Disposal:F—i,
Bar sine
Vegetable sink:--
Laundry/washing trap:
ka
Miscellaneous
Water piping /
Water e
Wate( hea
Lavatory (basin) -
Gas sys up to 4 outlets•
/�ub Panel -I Gas sys# of outlets over 4F--
Other
4 �J
Greasetrap:F—
Grease interceptocF--
P-trap:F—
Sewer
NV,—
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WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
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u CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
02 LLS,r�
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK-D-eVS-4b � n �G' -S ,4 -
y ESTIMATED $ VALUATION f �'
SWIMMING POOL ❑ �� SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Aoolicant
3. OWNER'S NAME
LAST
FIRST
ADDRESS
OWNER'S E-MAI L ADDRESS
CITY
STATE
ZIP
PHONE NO.
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
67),)-e005p:A- � a�E `
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No.
ADDREss
SS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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Forms\Pool spa appl (rev3-04).xls