HomeMy WebLinkAboutX2012-1350 - Permit ApplicationIL —,Punt Form . Worksheet for Building Combo Permit Application
r- Comm I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
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Kuilding F_ Grading [—Drainage I--1,Elec F—Mach[-";Plum CuYdcut CuYdFill v
F
Project Address (Not mailing address) Floor Suite No
Description of Work
Use F
# SmriesF7 # Units (if Res)[_
Valuation $
Material/Labor
New/Add SF�� RemodelSF177777 Garage/New/Add��7
OWNER'S NAME Last First
Owner's Address jV� Owner's E-mail Address
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City r 4�r �j State e/} ZipF_
o Telephone ^j
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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CityState Zip c�, _92fo[�_ j Telephone -_3 —(Poo
ARCH ITECT/DESIGNER'SNAME Last First F Lic. No.
Architect/Designer's Address J__O" / �/(` Architect/Designer's E-mail Address
r 1� Telephone
City ��!/ ------ State Zip 9ii
ENGINEER'S NAME Last First F77777 Lic. No.F
Engineer's Address Engineer's E-mail Address
City State Zip F--,_I TelephoneF�
CONTRACTOR'S NAME/COMPANY I Lic. No. Class 175_10--
- - — —
Contractor's Address Contractor's E-mail Address
City State -� Zip Telephone��j
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO. 1
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT 9 TOTAL FEES PAID$