HomeMy WebLinkAboutX2021-0643 - Permit ApplicationPrint Form
r Comm'I AResidential
Worksheet for Building Combo Permit Application �Ew�R>
$
City of Newport Beach - Building Division o4..� '
NOTE: PLAN CHECK FFF nl IF AT TInnF nF CI IRKAlTTAi o
[—Building [- Grading [-'Drainage r- Elec [- Mech r- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address)
Floor Suite No
3� PIS-►.Jeea-f a (� wAK J N6,4.iltr
'66,0 1 eA 9 Z 466o�—
Description of Work
Use
I
j ( 004—> > yYtC3t��I
/i'
# Stories[ # Units (if Res)F
V-%YLL 1(r IT
Valuation $
Material/Labor 5(y�
New/AddSFF— RemodelSFF—
Garage/New/AddF—
OWNER'S NAME Last r !Y
First
Owner's Address �
Owner's E-mail Address
143(o mawd(Nef w LIsQ\OtNa n i3 Q Ime cGRK
City FN ) 7t- YJ(��(,AA State l.p�
Zip %I,� Telephone 9 q 9
t
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City F— State F_
Zip [ Telephone F_
ARCHITECT/DESIGNER'S NAME Last First � Lic. No. G
Architect/Designees Address
Architect/Designer's E-mail Address
12-b 614" C frA&.7,ofITb
gBi_,eA&bPAl./-A,2e4ITf6T.cov.
City bi4VNA 3 fAev State �—
Zip 6 / Telephone ft I .1'I • owz
ENGINEER'S NAME Last I vbLf�
First ►¢o 5f,1r Lic. No. [fC ZSp
Engineer's Address
Engineer's E-mail Address
I-01v "KE ak✓E SuM 0_4
000 P, F,0 VO.Lf6
City I L.,A 4 Tv yr State 44
Zip 9Z6 Telephone 94 517oo
/Class
CONTRACTOR'S NAME/COMPANY L J �> Lu MMC, ] 1 r LS S _ Lic. No. � -3-ii ri rj-al
Contractor's Address
Contractor's E-mail Address
2LL�Ca:lwh-6� \71ii�..,
City l.iv fi r a H l �1 "} Cfl,-
N .r State
—wa
Zip Telephone I
i71rI 2 i6i �' tii
ENERGY P/C FEE $ FIRE P/C FEE $
PERMIT NO. _Z "1-4
GRADING P/C FEE $ PLANNING P/C FEE $
PLAN CHECK NO. 015M , 2p 2
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $ 14 1 •�,b I
DEVELOPMENT #
TOTAL FEES PAID $
3.31.2L
0,12-
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