HomeMy WebLinkAboutX2022-0322 - Permit ApplicationPrint Form
j-" Comm] r Residential
Worksheet for Building Combo Permit Application
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
F_Building r Grading rDrainage F_Elec r-Mech F-PlumcuydCut F cuYdFill F
Project Address (Not mailing address) Floor Suite No
26 TIDAL SURF
Description of Work
Use F
REPLACE 1 ST FLOOR DECK
# StoriesF # Units (if Res)F-
-
Valuation $
New/AddSF�—Remodel SF 218 Garaga/New/Add �
- - _—
Material/LaboF0,000
OWNER'S NAME Last bagheri First ali
Owner's Address Owner's E-mail Address
City State F Zip F — Telephoned
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State F Zip F TelephoneF—
ARCH ITECT/DESIGNER'S NAME Last First Lic. No. F—-
Arch itect/Designer's Address Architect/Designer's E-mail Address
City State Zip F__i Telephone
ENGINEER'S NAME Last First Lic. No.F—
Engineer's Address Engineer's E-mail Address
City �— State F__— Zip F_— Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. 56?Z" D Class
Contractor's Address Contractors E-mail Address �✓T 3GD?36 z3 1)'30`2�
City State F___ Zip F TelephoneF
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 $