HomeMy WebLinkAboutX2021-1537 - Permit Application= Works4eet for Building Combo Permit Application a2
Comm'I [j ResidXnt� 2-' C S 3� City of Newport Beach -.Building Division 5YI:)
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
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Project Address (Not rttalfing address) Floor Suite No
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Description of Work
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# StDriesIL #Units (if Res)
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Matedel/Labor (�j DI 1
New/Add SF�� Remodel SF1 Garage/New/Add
OWNER'S NAME Lest :1f'_ f✓ri First� -�
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last r Yi�---� Fl st
Appllcanfs Address Applicant's E-mail Address
City State F (T71n Zip y- Telephone V ' • _.. �" -
ARCHITECT/DESIGNER'S NAME: I(�. Lie.. No.
Last First -_J I fJ,K I �
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Arch[tect/Dealgner's Address Architect/Designer's E-mail Address- p
City SieteL"' Zlp "/ 7/J Telephone!l
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ENGINEER'S NAME Lest First �� Llc. No.�
Engineer's Address Engineer's E-mail Address
City State ��, Zip �� TelephoneC—�
CONTRACTOR'S NAME/CQMPANY Lie. No. Cglyass=
Contractor's Address � Contisctor's E-mail Address .-7s3gZU - '
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City !l i State �] Zip /I Z Telephone/' -O Cl D1v0
ENERGY P/C FEE $ FIRE P/C FEE $ PERMrr NO. to. � f
CHECK NO.
GRADING PIC FEE $ PLAN
PLANNING P/C FEE $ _
ELECIPLUIWIAECH P/C FEE $ _ PLAN CHECK FEE $
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