HomeMy WebLinkAboutX2011-0852 - Permit ApplicationWorksheet for building Combo Permit Application
Prrnf Falm s','" City of Newport Beach - Building Department
Please print 3 copies
10 wilding F Grading r-Drainage F_ Elec F_ Mech Plum
1. Proaect Address
address)
:a _ New?, l _GC:OTcCz IYAVk
Tenant Name(if Applicable)
Vh11 W2
130 NEW?Dd 6Wr
Floor Suite No
# Units (if Residential) i
2. Description of Work �� ® (m J �jY w+LCI
Use
V
Extg Building SFaluation $� Demo Building SF m. Add/Reconstruct Bldg SF ..,, A
Extg Gar sf Demo Garage sf �', Add/Reconstruct Garagejj''s``f""''''# Stories
TOTAL BLDG SIF 17 � 000
New � Add �': Alter l`mDemo Cu Yd cut
TOTAL GARAGE SF J Cu Yd Fill I �i
4. Arch itect/Designer's Name Last _%dVA) FirstF6® Lic. No. F3S? 13
Architect/Designer's Address Architect/Designer's E-mail Address
so s1 tiA,_►��acutL4A,su`Tt zr, zY��?3Ydt;E.Clb
City .,.,. _ State : Zip[ _.. e �. ._.�...._.m.�...-..... _
i`�Q�A�erJ� _ P Q// Telephone �zJ35/®33e%
Last .�A10(yC^2 ..... ....., First.-.�®S� Lic No
Engineer's Address Engineer's E-mail Address
�S IZ wus+a ar_� 13wq s_Lti� ts�oc�,f6osZ slACCogics
City LQe+ �ON6tTf.gS State C-4 Zip qOD\% Telephone
F_ 6. Contractor's Name Last �tJ�C�V �2— First J ®5t� Lic. No. 19 GO, Class
Contractor's Address
City rGp✓...'+1P6�td ....... State
ONLY ENERGY P/C FEE $
Contractor's E-mail Address
�NZ6ua?-.I @ 4lDCCo.co►/0
Zip 1460 1-7 Telephone 2/3, 2.3to-osoa
PERMIT NO.
GRADING P/C FEE $
Rev 4116109
ELEC/MECH/PLUM P/C FEE $
FIRE P/C FEE $ �y / o PLAN CHECK NO.
�F PLAN CHECK FEE $ l [ • �'`