HomeMy WebLinkAboutX2019-1049 - Permit Application101-19
- Worksheet for Building Combo Permit Application
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Residential City of Newport Beach - Building Division
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Project Ade$,r/EIS. sL (.6`kl�l¢-t I'db�a@i`iHB�g a-E$dCaS-S) � t 1 Floor to No
Description of Work "1kirle
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OWNER'S NAME Last First
Owner'sI Address Owner's E-mail Address
State CI1y-r �� Zlp� Telephone . �' 2O'�
APPLIGAlNT'S NAME Last � � First
Applicant's Address ApplicanPs E-mail Address
city O �(�/ —� State �� Zip �)/{ij "1 Telepho
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ARCHI'TECT11)ESIGNER'S NAME. Last —Hirst Lic, No
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Architect/Deslgner's Address ArchltecUDesignei's E-mail Address p
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city %t/ y ��rf��- State �i < Zip �L`LC'_ii _ Telephoner!�"�!
ENGINEER'S NAMES Last First �� � LIc. No.�J
5nglneer`s Address Engineer`s E -mall Address
city State �� Zip—� Teiephone[:::�
CONTRACTOR'SNAME/COM!"ANY f _ J Lic No.e, 10_ CIacS,
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Gontrector's Address Contractor's E-mail Address
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City \Cu\141 - __J State CVS � Zip _42Cot8 Telephone GVa-538-22R(d
NERGY PIC FEE $
>RADfNG PIC FEE $
=LECIPLUW1,AECH. P/C FEE $
FIRE P/C FEE $
PLANNING RIC FEE $
PERMIT NO. A0k_l • Int I
PLAN CHECK NO. 012A- 2,011
PLAID CHECK FEE $
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