HomeMy WebLinkAboutX2019-2299 - Permit Applicationrksheet for Building Combo Permit Appi!Gation
City of Nemrport Beach - Building Dkiision
J� NOTE PLAN CHECK FEE DUE AT TIME OF SUBIAFFTAL
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,Building [I Grading []Drainage KElec �Mech Plum cu Y - t Cu Yd Flli
Pr€ajar-t Addrass (Not mashing address) � Floor Suite No
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Des nptlon of Work � r Use [Fii 471wy,� IN
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v - #Stories #Units (if Res)
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Valuation
New/Add SF�— Remodel SF (/// Garage/New/Add �� Material/Labor
OWNER'S NAME Last �� j✓l First
Owner's Address Owner's E-mail Address
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City '�FZ)�/L/�" _I State �`i Zip �, I� Telephone
APPLPCANPS NAME Last —� Flrst �2%
Applicant s Address Applicants E -mall Address
city
0 �� State I— "' ' 1 ZIP Lp Telephone l� '�" -`��
ARCIiITECT/DESIGNER'S NAiillfl Last First jif�1(✓ —I Llc. No. C 2,�j qj
Archftect/Deslgner's Address Amhltect/Deslgners E-mail Addrese City N ��,State Zip171
2. iv6- Telephone G �`'�
ENGINEER'S NAME Last
First Llc. No,
Englnaei's Address Engineer's E -mall Address
City _ J State Zip -- Telephone,[ .
CONTRACTOR'S MANE/COMPANY
Contractors Address
City
=NERGY PIC FEE $
>RADING PIC FEE $
-i .-.��..i i �i ��i. •r-�i i nl� CCC P
�hLVc.Na�� ClassCl
/ f ✓ I� Contractor's E -mall Address
— I
State C—1 ZIP �_ J Telephone
FIRE PIC FEE $
PERMIT NO.
PLAN CHECK N0.
PLANNING PIC FEE
PLAID CHECK FEE $