HomeMy WebLinkAboutX2019-1986 - Permit Application-1no-1
Worksheet for Building Combo Permit A.pp6icadon
City of Newport Beach - Building Division
Comm'I Residential NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
[I Grading []Drainage )Elec hech 5A Plum cu Yd
Address (Nest rna@9aatg address)
of Work
cu Yd Fill
Floor sulte No
�rLN �y 1 /�
Use er r)Zb4V
II
# Stories J #Units (Lf Res)JI
1 gleno/ $ Kl
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New/Add SF J—J Remodel SF Garage/New/Add �� Material/Labor
OWNEWS NAME Last6 -f 12V��� � ` 1 First
Ownar`s Address Owner's E-mail Address
State �TelepMonelJ-1—
City —
APPLK;ANT'S NAME . Last
First
Applicant's Address Applicant`s E-mail Address
Gitv �(V- —1 State �� Zip I%/µi> Telephone
ARGHrrECTfDE!SIGNER'S NAidifi Last First �
R Designer's E-mail Address
Lia No.G �3
ArchitectfDeslgnar's Address _
City ���,/� State Ci!'K Zlp C�2��u_ Telephone
. First �� Ur. No.[---- J
ENGINEER'S NAME Last
Englneai's Address Engineer`s E -m dr s i '�
--I —
i
City State �� Zip
C:0N7RAGTC PWS fNALgElGOMPANY
Lic. No. 3AY ( 1149) CiassEk-7,
Contractors Address Contractors E-mail Address
- - City Telephone f ? 2 ( 1033
��✓Grp � State I _ Zlp
hiERGY PIC FEE $ FIRE PIC FEE $ PERMIT NO. 6
�u��� 1,., ��SL
PLAN CHECK NO. ��n–'�I ��+L ��
>RADING PIC FEE $ PLANNING PIC FEE $
:LEClPLUM(IAECH PIC FEE PLAID GHEGK FEE $
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