HomeMy WebLinkAboutX2012-1450 - Permit Applicationt PwntFrm K_"� Worksheet for Building Combo Permit Application
F- Comm'] F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
X2OIz 1450
47-1 C�v ITV
rBuilding F_ Grading Drainage 7_Mech
F- Plum CuYdCut �li CuydFiN
Proje•-ctt Address (Not mailing address)
Floor Suite No
Description of Work
Use
# Storiesn # Units (if Res)'
Valuation $
Material/Labor,
New/Add SF Remodel SF Gara e/New/Add I
OWNER'S NAME Last '
rt„_,,,,�.. Ga'_-
- ! First
Owner's Address
Owner's E-mail Address
City F:ir: iState
G
Zip �e% ?2-
APPLICANT'S NAME Last L` First
Applicant's Address
Applicant's E-mail Address -
_ 2& 7r_� __� _S - _
�a-.S Car ey 5,9� S • C�^�
City ._rS State I --1�'"
Zip 7 '� Telephone ?I/r.&O .841
ARCHITECT/DESIGNER'S NAME Last
First ; Lic. No. �l
Architect/Designer's Address
Architect/Designer's E-mail Address
-...... -___ ..... _ _ ...-...---- -
City — _� State ��.
--
-
Zip F _- Telephoned
ENGINEER'S NAME Last
First Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephoned
CONTRACTOR'S NAME/COMPANY r Lic. No. Class G 4�
Contractor's Address
Contractor's E-mail Address
City °� i b.. State
Zip Telephone
ENERGY P/C FEE $ FIRE P/C FEE $
PERMIT NO. <Cl
GRADING P/C FEE $ PLANNING P/C FEE $
PLAN CHECK NO.
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $
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