HomeMy WebLinkAboutX2016-1681 - Permit ApplicationWorksheet for Building Combo Permit Application
I r, OKI City of Newport Beach - Building Department
U011
Please print 3 copies
kBuilding r— Grading F.Drainage �(Elec ec
Mh F Plum
1. Project Address I
_ .... ...... .. . ......... -
Tenant Name(if Applicable)
2. Description of Work
Extg Gar sf F Demo Garage sf F Add/Reconstruct Garage sf
Floor Suite No
# Units (if Residential)
New F_ Add r— Alter ("""DemoTOTAL BLDG SF cu Yd Cut F77
TOTAL GARAGE SF F Cu Yd Fill F
-heck Appropriate Box for Applicant
F_: 3. Owner's Name Lastj First
Owner's Address Owner's E-mail Address
FTCA -ticz)
State Zip
City Telephone 5q�A�q,7,R(),
_iO_
f7 4. Architect/Designer's Name Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City StaterF zipi�iTelephone
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[-.5. Engineer's Name Last First Lic. No.
Engineers Address Engineer's E-mail Address
... . ... . ......... ...... .. .. .. ....
city . ...... . State Dw Zip I1��j.Telephone[
?,6. Contractor's Name Last FirstF Lic. No. Class
Contractor's Address Contractors E-mail Address
City State zip Telephone[�Jjf
OFFICE USE ONLY ENERGY P/C FEE $ PERMIT NO.
GRADING P/C FEE $ FIRE P/C FEE $ PLAN CHECK NO. 122
D.„AIIAMQ ELEC/MECH/PLUM P/C FEE $ PLAN CHECK FEE $