HomeMy WebLinkAboutX2013-0964 - Permit ApplicationX241� 0�Oq
Worksheet for Building Combo Permit Application
F— Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHFCK FFF DIIF AT TIME nF SI IRnnITTAI
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f—Building (`Grading F—Drainage FFlec r'Mech rPlum CuYdCut t! cuYdfill
Project Address (Not mailing address) Floor Suite No
2T7 _U(494vte� QboCcl/ �—
Description of Work
Use PITA
# Stories # Units (if Res)F
�-CteSyl,ue,V1- C�c�✓�e vo�� �c� � vovtc�e I- �c�_
Valuation $
Material/LaboF
New/Add SF�— Remodel SF �— Garage/New/Add F
OWNER'S NAME Last tivu e r First
Owner's Address Owner's E-mail Address
city eaCk �i /vQ�IJ•>µgC`)1"}' State t�Qq_ Zip.. C ((Q(p Telephone _.T �33`.1a3-7
APPLICANT'S NAME Last 1�oUS-e_v First V-
Applicant's Address Applicant's E-mail Address
City State C— Zip I Telephoned
I
ARCHITECT/DESIGNER'S NAME Last First'
_ Lic. No.
Architect/Designer's Address Architect/Designers E-mail Address
--
city State �— Zip Telephone
ENGINEER'S NAME Last First Lic. No. 5
Engineers Address Engineer's E-mail Address
Cit Y � State Zip F Telephonet
CONTRACTOR'S NAME/COMPANY Lic. No. �— Classt
Contractor's Address Contractors E-mail Address
City State �— Zip[ Telephoned
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 $