HomeMy WebLinkAboutX2011-1893 - Permit Applicationn-oil'6'b113
e.. Worksheet for Building Combo Permit Application
Print Form ,'',- City of Newport Beach -Building Department
Please print 3 copies
Building r- Grading F—Drainage F_ Elec F_ Mech r- Plnm
1. Project Address (Not mailing address)
Tenant Name(if Applicable)
Floor Suite No
# Units (if Residential) F
2. Description of Work \ie
� y Use
tj
Valuation $ � Extg Building SF�`"�'' Demo Building SF Add/Reconstruct Bldg SF tlr tJuo
tEx 1777
g Gar sf I! Demo Garage sf'_ Add/Reconstruct Garage sf #Stories
I �...._.....,.,. p'___,
TOTAL BLDG SF
New Add F Alter [—,.Demo _.... Cu Yd Cut
TOTAL GARAGE SIF - Cu Yd Fill I
F 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City
State Zip
_.
s b � ®.. Telephone �`6`t _ � ,, T..
F ; 4. Architect/Designer's Name Last
11� -
First
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City F�,
State ��. Zip Telephones _.......
mm
_..............
5. Engineer's Name Last
First
Lic No.� ...r
Engineer's Address
p
.0
Engineer's E-mail Address
Clv
City \c4 ......._ .........
State €
4 Zip
_ B l��'Y Telephone@` m �✓� " ��
( 6. Contractor's Name Last i �t J c n °� First Lic No. Class 0 h da @
Contractor's Address Contractor's E-mail Address
��
1 _D1Bay bs -Ai AZ
City _ p�_. \ ......._.._ .._.._... _ ..... .......
A��9�� State r Zip �dTelephone_VQgZ ....
OFFICE USE ONLY ENERGY P/C FEE $ PERMIT NO.
GRADING P/C FEE $ FIRE P/C FEE $ PLAN CHECK NO. ` O la I�
Rev4116109I E EC/MECH/PLUM P/C FEE $ PLAN CHECK FEE $