HomeMy WebLinkAboutX2013-1166 - Permit ApplicationWorksheet for Building Combo Permit Ap 'cation AEW ART
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Comm'I J,;Z, Residential City of Newport Beach - Building Division '/n
NOTE: PLAN CHECK FEE DUE AT TIME OF SUB (ytN
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Building Grading J—Drainage rZEIec �Mech Plum Cu Yd cutl Cu Yd Fill
Project Address (Not mailing address) E N/)",ak( Floor Suite No
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Description of Work SRZ
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Use � CIAC �/I,(
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# Stories& Units (if Res)
Valua
00New/Add
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Remodel SF T$II Gara e/New/Add ij
SF _'=
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OWNER'S NAME Last P4j (RCN First
Owner's Address
Owner's E-mail Address
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City G, -µ - J State G. J ZiP Telephone
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APPLICANT'S NAME Last MWTS4Z6 First
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Applicant's Address Applicant's E-mail Address
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City State ��'h j Zip "i Telephone
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ARCHITECT/DESIGNER'S NAME
LastFirst i
J1, Lic. No. 1_iCt2�
Architect/Designer's Address Architect/Designer's E-mail Address (p.
City I State Zi Tele hone -7m
ENGINEER'S NAME Last �- First F777 Lic. No.�
Engineer's Address Engineer's E-mail Address
City State E ZIP [ Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. Class 7
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Contractor's Address Contractor's E-mail Address
City State C Zip Telephone[—
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO.
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $