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1
Worksheet for Building Combo permit Application
City of Newport Beach - Building Department
Building ml Grading F-Drainage r- Elec F' Mech f— Plum
Project Address (Not retailing address)
6-76 MffWPoX;T- CEWTeJX Z)MVt; -_
Tenant Name(if Applicable)
2. Description of Work
Floor Suite No
# Units (if Residential) F„m5
Use
Ext Building SF
Demo Buildin SF
Valuation $
9 9
9 i
Add/Reconstruct Bldg SF
.. .......... .,,,
Ext_ Gar sf !
9 III
9
Demo Garage sf ��',.,,
Add/Reconstruct Garage sf I�"'''''"'"
# St01'Ie5 E �,
..
( New ('" Add
� Alter ("',Demo
TOTAL BLDG SF I
f
_ I Cu vd Cut
TOTAL GARAGE SF
Cu Yd Fill
Check Appropriate Box for Applicant
0
j, 6. Contractor's Name Last First DS �, Lic. No. ? 2?66Y Class A B
[_ .
Contractor's Address Contractor's E-mail Address
Ott wcts14tt_E �cut�-�sut1� r 0 tN,6v��,@ a�1�Cco.�nt�a
City /etts N667(, d State Zip 700 1 7 Telephon ZP3)236—oTQ
USE ONLY ENERGY P/C FEE $
PERMIT NO.
GRADING P/C FEE $
Rev4116109 ELEC/MECH/PLUM P/C FEE $
FIRE P/C FEE $
PLAN CHECK NO.
PLAN CHECK FEE $