HomeMy WebLinkAboutX2019-2871 - Permit Applicationf Worksheet for Building Combo Permit AppliGation20
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r City of Newport Beach - Building Division`
j, CorFrm'I [Residential hUITF- PI AN CHECK FEE DUE AT TIME OF SUBMfTTAL _
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Proiaot Addras<s (Mat mailing addrars)
Description of Work
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Blew/Add SF
Cu Yd
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Cu Yd Fill
Floor Suite No
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Use j fl i 7�r—w A
# StcriesA # Units (if Res)EI
Valuation $
Remodel SFZ°7 Garage/New/Add [�---� Material/Labor
0WNER'S NAME Last [ � . �i(21��!✓'i � � First
Owner's Address Owners E-mail Address
city I State [I Zip Telephone
APPLVGANT'S NAME LRst � Flrst PK_ --�
Applicant`s Address Applicant`s E-mall Address
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City State [[�� Zip I7/�7 1 Telephone �p -
ARCHITECTIDESIGNER'S NAME: First L� I Lic. No.
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Last _ I _ —
/Architeci1Designer`s Address _ ArchltectlDesigner's E-mail Addrese p
State [L/� Zlp Fqa,( Telephone
City LL �— ----
ENGINEER'S NAME Last First — Lic. No.
Englnear's Address Engineer's E-mall Address
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City — --- State [� Zip —1 Telephone _ _ J
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�OI�TRAGTDR'S NAME/C�iV RAIVY — ---- —
LIc. No. r✓ 'L
Contractor's E-mail Address
Contractor`s Address
200 Teti,— 0 D S Lt 1•ye 1C
City I -ClrvihAt I State L[ ZIP `li, 61 Telephone �1{�j `75�-�1a a
NERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
3RAD114PLAN CHECK NO.
G P/C FEE $ PLANNING P/C FEE $
PLAN GHECI< FEE $
_ECIPLUM/MECH P/C FEE $
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