HomeMy WebLinkAboutX2012-1437 - Permit Application„Print Farm '
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Worksheet for Building Combo Permit Application 4 Sail j006tu'oll
City of Newport Beach - Building Division `u M pl
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL »oa^''
Building F-Grading F-Drainage F_Elec rMech r, Plum cu Yd Cut Cu Yd Fill FI
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Project Address (Not mai ing address) Floor Suite No
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Description of Work
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#Stories #Units (if Res)
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Valuation$
New/Add SF�� Remodel SIF Garage/New/Add � i
Material/Labor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
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City �t//„r�)a0�.C,gC/'y = State wad Zip—.. TelephoneF�.
APPLICANT'S NAME J --
Last_.._�lr� First
Applicant's Address Applicant's E-mail Address -
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ARCHITECT/DESIGNER'S NAME Last First
- Lic. No.
Arch itect/Designer's Address Architect/Designer's E-mail Address
City State Zip Telephone
ENGINEER'SNAME Last First ( Lic. No. F�
Engineer's Address Engineer's E-mail Address
City State Zip Telephone�—
CONTRACTOR'S NAME/COMPANY - _ Lic. No. L i p Class CGD2
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Contractor's Address Contractor's E-mail Address A e*5
Cityr�-,.7-�-, „-_---_ -,._ State �I Zip -�, ��,,,. Telephone 7r
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 $