HomeMy WebLinkAboutX2011-3043 - Permit Applicationr Comm'] r Residential
Worksheet for Building Combo Permit Application
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
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rBuilding r Grading rDrainage FElec rMech r Plum Cu Yd Cutl IIIII Cu Yd Fill
Project Address (Not mailing address) Suite No
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Description of Work
Use
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# StoriesT # Units (if Res)
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Valuation
New/AddSFF77777 Remodel SFF` Gara e/New/Add
$
Material/Labor
OWNER'S NAME Last j+ePPK 6F First K -ehi-
Owner's Address Owner's E-mail Address
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City .NuWQcAx--r 'Q(3AcAk; State C./�- Zip yZ.../��� Telephone
APPLICANT'S NAME Last {OCR1-po> First 4 a .ems S 3
Applicant's Address Applicant's E-mail Address
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City 1,...-N l�-.\is3 State (- Zip _m1'�.la �'3.; Telephone ;1`1r-3Y'Z,1ZG _._..
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ARCHITECT/DESIGNER'S NAME ,�— w7��u. r+ L
Last I 1"r'4Ptj'4,�� First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip �%fQ5`} I Telephone
ENGINEER'S NAME Last First Lic. No I
Engineer's Address Engineer's E-mail Address
City State F Zip F Telephoned
CONTRACTOR'S NAME/COMPANY �T,J � S Ld%rll-q- I-W" Lic. No. 3{��q Class 3 GlU
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Contractor's Address Contractor's E-mail Address
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City i�ll_5 State �sd`. ZiP1 Telephone �Y%..1�`�"� �1Ta2S9
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ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO.
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $