HomeMy WebLinkAboutX2010-3066 - Permit Application (3)Print Form Wo ksheet for Building Combo Permit Application
r 1 City of Newport Beach - Building Department
Please print 3 copies 0
NBuilding F Grading ("Drainage Xilec AMech GVPlurn
1. Project Address (Not mailing address) Floor Suite No
FN—/A
Tenant Narne(if Applicable) # Units (if Residential)
F� J4 LN
2. Description of Work
Use
................ ................
Extg Building SF
Demo Building SFValuation $
F/ 7 Add/Reconstruct Bldg SF
Extg Gar sf J Demo Garage sf Add/Reconstruct Garage sf I fi # Stories
TOTAL BLDG SIF A Cu Yd Cut
f_.. New F_ Add Alter F!_ Demo
TOTAL GARAGE SF Cu Yd Fill
rhark
3. Owner's Name Last
FTf qt
Owner's Address
Owner's E-mail Address
In -
City 44c: f (-�I
A
i .2
State Zip Telephone i
4. Arch itect/Designer's Name
Last Lic. No.
All-"Wic, _F7
Architect/Designees Address
Architect/Designees E-mail Address
City F -Z�z�,.
State Zip. r77_1 - v
F Ed�, TelephoneR��T
er's Name Las 5. Engine t
t
f�7 s Lic. No. F
Engineer's Address
Engineers E-mail Address
. ...............
. .... ..... . .. .... .......... . . ..... ..
. .................. ........
City
..... . ...... ...... ..... ......... .................... .. ...........
State ZIP Telephone[
F_ 6. Contractor's Name Last First 7
F777777Lic. NOT — Class
Contractor's Address
. .....
1`�L .1 ---, mail N g 0
htfActor s E-mail A
ress
City
ity
State
State Zipl� Telephoned
OFFICE USE ONLY ENERGY P/C FEE $ 6— PERMIT NO. 1010
GRADING P/C FEE $
FIRE P/C FEE $ PLAN CHECK NO,
Rev4116109 ELEC/MECH/PLUM P/C FEE $ PLAN CHECK FEE $