HomeMy WebLinkAboutX2012-0204 - Permit ApplicationPrint ForrrZ'',. Worksheet for Building Combo Permit Application
F comm" Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
�LUIZ UZD4
R
U S
G4eorvh•�
Lli
2�) din Gradin g �, Plum cu Yd cute Cu Yd FiilF
g g (�Draina e Elec Machojlect
Address (Not mailing address) Floor No
.�Suite
_� ` �A/Vr� 1�` ��"' -_��Q� '� � � • L-fit.✓�lll1--�--'--"��I'__`�-�
Description of Work
Use %
�
# Stories, # Units (if Res)
Valuation $
Material/Labor
New/Add SFF7� Remodel SFF— Garage/New/AddF___7
OWNER'S NAME Last fIn Z First
Owner's Address Owner's E-mail Address
City n„��Gf-� State F_(��, Zip _ Telephoned
APPLICANT'S NAME n� First Z Uastl t' (QA"�---1��—'Cz�/j GL___ I
mm _
Applicant's Address App'san.' -mail Address
i
City F -_ _ State F-7, Zip [7777 Telephone -
ARCHITECT/DESIGNER'S NAME Last _ . First F- Lic, No. �jl /-6 '
Architect/Designer's Address Architect/Designer's E-mail Address
City F TZ� L I/YI-V -. _ . State-.'p'vl, Telephone
ENGINEER'S NAME Last ���� � — First �L 17 Lic. No. r cGr5
_'�` ``J
Engineer's Address Engineer's E-mail Address
/..Gn
fn�/�a®dam
!v"UI�-.'��G.'...
/�.
� _i_.fi� � I 1 V • ((1:7f:1 i � lr��,
City .�V{m.N�IN�........ _-- �,, State �'�._.. Zip�� Telephone I
CONTRACTOR'S NAME/COMPANY Lic. N _ Clas
P( -7
.
Contractor's Address `✓ Contractor's E-mail A r ass
City State„
EN R Y P/C FEE $ FIRE P/C FE �P MIT NO.
ADI G P/C FEE $ VL �L
PLANNING P/C EE $ N CHECK NO.
l
IL C LUM/MECH P/C FEE $
PLAN CHECK FEE $
ELOPMENT # TOTAL FEES PAID $