HomeMy WebLinkAboutX2021-0176 - Permit Applicationp worksheet for Building Combo Permit App5Cat1on
r City of Newpw Beach - Building Division
Comm'I Residential i, in=- of AM rrw Grru r=FF N IF AT TIMP: (-)F SI JRMITTAL
'KIBuilding [I Grading F]Dralnage Elec ) IMach Plum CuvdCut� —J Cu Yd Fill ]
Prajact Address (Nest mal iing address.) Floor Floor Suite No
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Descriptian of Work
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# Stories) s '( # Units (it Res)LI
Valuation
Nevv/AddSF_____l Remodel SF Z are dc[7 Material/Labor V
OWNER`S NAME LastFl2vm)i First
Owner's Address owner's E-mail Address
City ' �/V I/ _ --I State Zip Telephone �U
APPLiCANT'S NAME Last —� First
Applicant's Address I Applicant`s E -mall Address
City � � ��/ � State ZIP )/�� Telephone ��„
ARCHfTECTfDESIGNEIt'S NAM[:. Last —J First tiL — LIc. No. G
ArchitectfDeslgner's Address Archltect/Deslgnet's E-mail Address p
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City State /� j ZIPME Telephone
ENGINEER'S NAME Last[ First�� � Lia No.E___�]
Engineer's Address Engineer's E-mail Address
city _ State Zip �� Telaphon®[�
COKITRACTORR''SSNAME/COMPhIVY �, LIc, No. Class )
Gohtre t�r's �ddke s 1 \ Contractor's E-mail Address--F�--F��—�—
city \/6�V��---� State
LCR -1 ZIP I Telephone
ENERGY PIC FEE $
GRAD114G PIC FEE $
ELEC/PLUPA/MECH PIC FEE $
FIRE P/C FEE $ PERMIT NG./i A — 10-710
PLANNING PIC FEE $ PLAN CHECK NO. Oct Q 7W Z
6 — (
PLAN CHECK FEE $