HomeMy WebLinkAboutXC2023-0030 - Permit ApplicationPrint Form
,�_Comm'I r- Residential
Worksheet for Building Combo Permit Application ON,
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
F-Building F_ Grading
r"Drainage F_ Elec F_ Mech
F_ Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address)
Floor Suite No
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Description of Work
Use
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L41f&<,L-
ZFar�ers
# Stories #Units (if Res)
y,
Valuation $ 13� 00 0
Material/Labor
New/Add SF � Remodel SF F Garage/New/Add �
OWNER'S NAME
Last C7e(terv� kl&,Vro
First I L JD
Owner's Address
Owner's E-mail Address
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City �� .�-
State l CA
Zip ZC6 �j Telephone qq-7o3 9
APPLICANT'S NAME
Last 'l First,wJkr
Applicant's Address
Applicant's E-m�/a//il Address
(5 c) F_rU, 5 f qa) b
e ,'� e e bird %re el\, wa dA-a to�
City Ivey AAA f
State l�l
Zip T(C(f( Telephonel S�D 51Cj—Zo323
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
ArchitecttDesigner's E-mail Address
City
State
Zip. Telephone!
ENGINEER'S NAME
Last �� /,, s
L
First � /-IQr Lic. No.
Engineers Address
f
Engineer's E-mail Address
15 00
00 23
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City VLlsl ��(�`
State C�
Zip Telephonel,
CONTRACTOR'S NAME/COMPANY r vlakv-
l /
cv pwe� Lic No. l Mo3p Class!
Contractor's Address
Contractor's E-mail Address br &19 910q/
15500
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City V(''I%i /Vu��
State A-
Zip!! 9)! Telephone�8—Spq--'1o3�
ENERGY P/C FEE $
FIRE P/C FEE $
PERMIT NO. xS[�
GRADING P/C FEE $
PLANNING P/C FEE $
PLAN CHECK NO.
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $