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Print Form Worksheet for Building Combo Permit Application DREW° Rrm DY
City of Newport Beach - Building Department
Please print 3 copies
15?Building F Grading ('"Drainage ( Elec (-' Mech I- Plum
1. Project Address
_.
1650 NCD-.m._-._.__.
Floor Suite No
Tenant Name(if Applicable) # Units (if Residential)
2. Description of Work
. _ Use
V,VaIIL,7T W x'i'-6 5 H, Nlll'M162 W x 2'-4 H —�_ _._..._„.____._._ _ __ _.—.__.___.. ,. .. _...
Valuation $ q,
Extg Building SFF Demo BUllding SF Add/Reconstruct Bldg SF
Extg Gar sf Demo Garage sfAdd/Reconstruct Garage sf k Stories
TOTAL BLDG SF r
New _._. Add Alter f-"Cu Yd Cut
(' Demo
TOTAL GARAGE 8F Cu Yd FIII
Check Aporoorlate Box for Anolicant
Ix 3. Owner's Name Last Icarey
First Tim
Owner's Address
91D Innovation
Owners E-mail Address
tcarey@irvinecompany.com
City Irvine State
Zip f92617 _ Telephonel949-720- _
2000
JR 4. Architect/Designer's Name Last Kelly
First James Lic, No. i
Architect/Designer's Address
5161 California Avenue, Suite 100
Arohitect/Designer's E-mail Address
gbroming@lpainc.com Gloria Broming
City Irvine State
rCA
Zip j92617 Telephone 949.261-1001
N 5. Engineer's Name Last McLellan
First (Mark Lic. No (511 1031
Engineer's Address
19 Technology
Engineer's E-mail Address
pat. Osborne@stantec.com
City !Irvine State
[CA
Zip I92616 Telephonel949-923-6000
iX 6. Contractor's Name Last �TBD
---_--_ F------..
First j Lie. No. Class
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 N0.`
PLAN CHECK N0.
Rev4116109 ELEC/MECH/PLUM P/C FEE $
y
PLAN CHECK FEE $