HomeMy WebLinkAboutXR2023-1398 - Permit ApplicationWorksheet for Building Combo Permit Application SN�i,
Comm I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
F-Building r-Grading F-Drainage r'Elec F-Mech F-Plum Cu Yd Cut t Cu Yd Fillt
Project Address (Not mailing address) Floor Suite No
Description of Work
Use
#Stories #Units (if Rest
New/Add SFRemodel SFGarage/New/Add
Valuation$
Material/LaborV�,
OWNER'S NAME Last tu J First
Owner's Address Owner's E-mail Address
City -.-_ State r � Zip Telephone
APPLICANT'S NAME Last L� M ` ( - - - First
Applicant's Address Applicant's E-mail Address
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City � N --- State Zip '� b Telephone �.1�3> L
4�1
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address -
city State Zip Telephoned'
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
,
.
2 (Z,)(- - -..- ---- ----- --- ----
City State 1--
ZipTelephone I
s � fvt _ tit 9 �' 0 5
CONTRACTOR'S NAMEICOMPANY I�US �f� Lic No. 3�� h� ClassP
----
Contractor's Address Contractor's E-mail Address
City
— t'''r- -4 -------- State � Zip (V7 L Telephone `] 1 � J._��..: 1 ( I (
Z
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO.L� /2
ELEC/PLUM/MECH P/C FEE $ , PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $