HomeMy WebLinkAboutX2021-1538 - Permit ApplicationWorks4eet for Building Combo Permit Application
CorFim'I Residential City of Newport Beach -. Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
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Project Address (Neat mailing address)
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Description of Work
New/ SF�-� Remodel SF Z Gerage/New/Add
OWNER'S NAME Last
First
Cu Yd FM U
Floor Sulte No
L
use
# Stories[] # Units (if Res)EJ
Valuation $
Material/Labor t
owner's Address Owner's 0-mall Address
City fJ State [- + ZIP Telephone
APPLiCANT'•S NAME . . Last
Appllcanfs Address
city
ARCHITECT/DESIGNER'S NAME Lest
ArchitecE/Designer's Address
City State L.
First
Applicants E-mail Address
Zip I q joW I Telephone
-, First L►c., No.
Archliect/Designars E-mail Address
Zlp_ (� Telephone_
ENGINEER'S NAME Last _ First Llc.No.=
Enginser's Address
City State
GONTRAcTOR'S-NAME/CQMI"ANY
Contractor's Address
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City I i�U L V t State C
ENERGY P/C FEE $ FIRE P/C FEE $
GRADING P/C FEE $ PLANNING WC FEE $
Engineer's E-mail Address
ZIP I • I T
Lic. No. 3(? ) I k4Class
Contractors E-mail Address
LillC l a e � ►rt C Corgi
Zip G� 2 o i Telephone C��-� �" o��Jl� "` � 1 !
PERMIT NO.
PLAN CHECK NO.
k
PLAN CHECK FEE $
ELEC/PLUM/IJIECH P/C FEE $ _ .