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Worksheet for Building Combo Permit Application
City of Newport Beach - Building Department
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('"!,Building F Grading F—Drainage r— Elec F7. Mech I""', Plum
1. Project Address (Plot mailing address
Tenant Name(if Applicable)
2. Description of Work
Extg Building SFj Demo Building SF ( Add/Reconstruct Bldg SF
tt ...............
Extg Gar sf Demo Garage sf F Add/Reconstruct Garage sf
TOTAL BLDG SIF
77 New F_ Add F_ Alter ('''•,,Demo
TOTAL GARAGE SF
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q23 ��i I�t"c* rnlgy
Floor Suite No
7',
# Units (if Residential)
Use
Valuation $
# Stories F,
Cu Yd
Cu Yd FIII
( 4. Architect/Designer's Name Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State I Zip F F77777
6. Contractor's Name Last` First Lic. No. lass ��
Contractor's Address Contractor's E-mail Address
City State Zip Telephone
OFFICE USE ONLY ENERGY P/C FEE $
GRADING P/C FEE $ FIRE P/C FEE $
PERMIT NO.
PLAN CHECK NO.
Rev4116109 ELEC/MECH/PLUM P/C FEE $ __ PLAN CHECK FEE $