HomeMy WebLinkAboutX2020-0504 - Permit Application2®2® - pS`Dq
Worksheet for Building Combo Permit Appilcafion �
rCo r m'I Residential City of Newport Beach - Building Division e
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
r
&uikding [Grading [ Drainage �.Elec j�Aech Plum Cu Yd Cut=
ut
L
I
I Cu Yd Fm �;
J
PrcbjaCt Address (Not PA affing address,)
—
FFloo-'�rl� Suite No
Description of Work
lir✓ k- `11
Use
pt�- i1 � ���� O�V
# Stories f Units (IF Res)F
i
New/Add SF Remodel SFGarage/New/Add
Valueflon
Material/Labor V(/
OWNER'S NAME Last . -f'ZV1a/I% _ First
Owner's Address Owner's E -mall Address
- Clry - � _ State Zip v� � � Telephone
� •�O— 4
fSPPLPCAFIT'S NAME Last — First I
Appllcarnfs Address Appbcant's E-mail Address
Lq�u
City D �� State �� Z'ip )/{jF— Telephone�L.S�"
7,4,
ARCHIFTECT/DESIGNER'S NAME: Last //�7{�/r First
`-i-4 -
Lic. No.
Architect/Designer's Address A. ArchitecUDeslgnarna---t.FFFs E-mail Addrese p
City State Giles Zip g2"�Gd- Telephone ff ° „ ,,
ENGINEER'S NAME Last [ —� First ��
Llc. No,
Engineers Address Engineer's E -mall Address
City State Zip E___1 Telephone
J .�
CONTRACTOR'S FdAIME/GOMPIANY (J 2/ j Lic. No. N --0� (� 7y*lasslli_l
Contractor's Address Contractor's E-mail Address
City - \z\ i a _ J State 56A] Zip F� % o Telephone6
4 �yf6J Lrl sl ()
ENERGY P/C FEE $
GpRADING P/C FEE $
ELEC/PLUM/MECH P/C FEE $ _-
0 FVELOPMENT #
FIRE P/C FEE $
PLANNING P/C FEE $
PERMIT NO..?�r'..d
PLAN CHECK NO.
PLAN CHECK FEE $
TOTAL FEES PAID $
Nl-