HomeMy WebLinkAboutX2021-1591 - Permit Application$ice"� Worksheet for BuHding Combo Permit Appiication
rity of Ne nrpo l Beach -Building Division
%y Comm'[Co'I ❑ Residential
NOTE: PLAN CHECK FEE DUE AT TIME OF SURhAIITAI
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Pc'rajaot,.Address (Not mailing address)
Floor � Suite No
Description of Work
Use
Stott P Units {If Res)D
Valuation S
Material/Labor
New/Add SF�� Remodel SF i U Garage/New/Add
OWNER'S NAME Last .�ZIyIJI/I' �. First
Owner's Address Owner's E-mail Address
City State Zip
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APPLMANT'S NAME Last � First K
AppllcanY's Address _ Apptlicant's E-mail Address ` 6 /, h
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City �' �{'j state Zip L{tj Telephone �y %/�i
ARCFIFFECTfDESIGNIER'S NAME Last First -� � Llc. No.WPMD
Arch ttec[/Designer's Address Amhltect/Deslgners E-mail Addrese p7
City . k,-,� L l� j Zlp C `7� t� iv(� Telephone[L
T7 �r r�� Slate i�-' -
ENGINEER'S NAME Last First �] Llc. No.��
Engineer's Address Engineer's E-mall Address
City State Zip TelaphoneF I
CONTRACTOR'S AlgPtryE/CQMPFrNY �� N{.,{ / Llc No. a�� { Li� class
Contractor's Address Contractor's E-mail Address
Kve, MO eGtl _ c>;��L�
CityF I QUt NE state vL_ Zlp I5 Telephone . ;�g a - i%,L4g
-WERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO. ZA
DRADING PIC FEE $ PLANNING P/C FEE $ PLAN CHECK NO. ,� l
LEC/PLUhNIIv1ECH P/C FEE $ - - PLAN CHECK FEE $n
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