HomeMy WebLinkAboutX2012-1164 - Permit Applicationy;�012 -1164
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Mof Form 1 Worksheet for Building Combo Permit Application
Corsi F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
wilding F_ Grading f-Drainage IElec rMech rPlum CuYdCut cuydFill
Project Address (Not mailing address) Suite No
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Description of Work
Use
.�r�N."r-�•- ili"�' /'�'�-"Y•'%ILLY O'�� dlf�
# Stories # Units (if Res)[ ----
Valuation
New/AddSF�� Remodel SF Garage/New/Add
abor
Material/Labor��I
OWNER'S NAME Last �idotd� %r - -- First --- -- ---
Owner's Address Owner's E-mail Address
City � State Zip[—TelephoneF_
APPLICANT'S NAME Last First(
- ___ _',
Applicant's Address Applicant's E-mail Address
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City.�g '. State r Zip - i Telephone
ARCHITECT/ ESIGNER'S NAIi� Lass First Lic. No
Architect/Designer's Address Architect/Designer's E-mail Address
City F State s Zip Telephone[
ENGINEER'S NAME Last r -- First Lic. No F�
Engineer's Address Engineer's E-mail Address
City -_ -- . State �� Zip F Telephone —
CONTRACTOR'S NAME/COMPANY -� vt �/� _ Lic. No. 0 Yf Class
r
Contractor's{Addresss Contractor's E-mail Address
City -_ --, State �� Zip 1t3(�� Telephoned
--- _._
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO. (Hi's - t/
ELEC/PLUM/MECH P/C PLAN CHECK FEE $
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�{FEE
DEVELOPMENT # CJ flX�' G� 12— 1a- ° C)_Zo TOTAL FEES PAID $-