HomeMy WebLinkAboutX2021-0553 - Permit ApplicationI,
Comm'] F1 Residential
Worksheet for Buliding Combo Permit Application00,�
CCity of Newport Beach - Building Division . - )CZE a I - oSr3
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I Ahl WP:rlf FFF MIF AT TIMFnOF SUBMITTAL
) Building ❑Grading r.]Dralnege �6tlElec j4hech I hr'uvdcut= CurdFln
//Project
Address (Clot (mailing address) Floor Suite No
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Description of Work
Use
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# Stories # Units (if Res)E]
Valuation $.
MatedeVLebor
New/Add SF �� Remodel SF _ Gerege/New/Add
OWNER'S NAME LastHE :-j�Ztfjtl _ �p. First
Owner's Address Owner`s E -mall Address
' city -� f✓r —� State ��i� 7ip�-L] Telephone
APPLICANT'S NAME Last First
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Applicants Address ApplicenPs E-mail Address
City tate Zip Y Telephons
ARCHITECT/DESIGNER'S NAME LastFirst )//XVI Llc. No.
Archltect/Deslgner's Address !! Archltect/Deslgners E-mail AddresF'
City tvr �i Statetl Zip C�7 _%� Telephona ffl �= - l�
ENGINEER'S NAME Lest First E=—::] Llc. No[::�__
Engineer's Address Engineer's E-mail Address -
CRy_ L� State ZIP _� _Telaphone��
CONTRACTOR'S NAME/COMPANY (� N LIc No. 391 j r✓�C CIasS�
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Gon4ntracactor's Address � Cotor's E-malldress -
7 _Sti:vininc � o
City �� dv� StateZip a7: IP Telephone
ENERGY PIC FEE $
GRADING PIC FEE $
FIRE P/C FEE $
PLANNING PIC FEE $
PERMIT NO. Lb2q • � S
PLAN CHECK 0. D j
ELECIPLUIvt/N1ECH PIC FEE $ _ PLAN CHECK FEE $
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