HomeMy WebLinkAboutX2011-0328 - Permit ApplicationWorksheet for Building Combo Permit Application
City of Newport Beach - Building Department
Please print 3 copies
J—;Building r.—. Grading I —Drainage r- Elec
F Mech r Plum
1. Project Ai
TFf S_
Tenant Name(if Applicable)
2. Description of Work
Extg Building SFJ i Demo Building SF I :� Add/Reconstruct Bldg SF I
Extg Gar sf F77 Demo Garage sf F777 Add/Reconstruct Garage at F
TOTAL BLDG SF
F_ New F_ Add Alter (',Demo I I .
TOTAL GARAGE SF [_
F_ 4. Arch itect/Designer's Name Last
First
Floor Suite No
F F..
# Units (if Residential) F I
Use
Valuation $ F/
# Stories
Cu Yd Cut
Cu Yd Fill
Arghec�t,/Designei Address Architect/Designer's E-mail Address
City Fr, - - ----- State Zip Telephone
Lic. No.
f7 5. Engineer's Name Last First F77777 I-C. No. F
Engineer's Address Engineer's E-mail Address
.. . . . . . . . ... . . . ... - - . ... . ... . .. . , , __
City State Telepho
... .. . .... . ...... .... ..... ... . F
City State Zip Telephone
I , F I
OFFICE USE ONLY ENERGY P/C FEE $
PERMIT NO.
k-e
Lill
GRADING P/C FEE $
Rev4116109 ELEC/MECH/PLUM P/C FEE $
FIRE P/C FEE $
PLAN CHECK NO.
PLAN CHECK FEE $