HomeMy WebLinkAboutX2018-3649 - Permit ApplicationViiorksheet for Building Combo Permit Application �vlk�'
Comm I ❑ResidentialCity of Newport Beach - Building DivisionNOTE: PLAN CHECK FEE DUE AT TIME OF SUBJAF TAL
��`t IBuiiding [ Grading F]Drainage IElec r6dech /t Plum CuYdCut E cuYdFill
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Floor Suite (NNo�
Proje ct [Address /(��ehott mailing address) r / I
Description of Work
Use P P�II •vimIN�
# Stories❑ k Units (if Res)
Valuation $
Material/Labor
j� Remodel SF
New/Add SF
— i Z Garage/New/Add
OWNER'S NAME Last � fftl�� � First
Owner's Address Owners E-mail Address
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�Al state ] Zip 7� L Tetephone��'�-
APPLECANT'SNAME Last First
Applicant's Address Applicants E-mall Address
City �(�/ State Zip y{j TelephoneLii�_T
ARCAFFECTIDESIGNER'S NAME; ry�r�, A
Last � First l Li I LIc. Na
Amhitect/Deslgner's Address Archltect/Deslgn—et's-E-mail Addrese '
A r // _ /L /
City /V�}7 Zi�./�; _I State FP__ i Zip F `� _21. 7910 I Telephone)
ENGINEER'S NAME Last First �� Llc. No. _J
Engineer's Address Engineer's E-mail Address
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Zip �� Telephoner
City -_ State ��
CONTRACTOR'S I11RttEEICOMPFtIVY//_� Lic. No, classC
I-
Contractors Address Contractors E-mail Address -
City - State �I Zip J Telephone..........
ENERGY P/C FEE $
FIRE P/C FEE $
GRADING PIC FEE $ PLANNING P!C FEE $
ELECIPLUM/MECH P/C FEE $
PERMIT NO. YU1 0 .66"
PLAN CHECK N0. 2$? AVII 8
N'lao
n PVPI rI hfiFIJr 8
PLAN CHECK FEE $