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HomeMy WebLinkAboutX2012-1462 - Permit Application22021L Worksheet for Building Combo Permit Application r Comm f — Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL 1, LCi2- IgO-2 i003 MONO - Center Pe, [7Building F_'', Grading f—Drainage f—Elec F—Mech FPlum Cu Yd Cut Cu Yd Fill v Project Address (Not mailing address) Floor Suite No d / xC v �^ pe A� 0, '- Awff i� 56 c tion of Work 1 Use F IN r+,Gt S7�Ecl � 5;; �EXPGs'Fi7 �CriN, ��1NaU�2 l� # Storiesn # Units (if Res) ; Valuation$ Material/Labor � New/AddSF RemodelGarage/New/Add � OWNER'S NAME Last(JU�'- First K� Owner's Address Owner's E-mail Address le ---�_. 16/1'r°'�P`IS Ei-Qd(• City 1C97A,✓l./47� -.--_ ... State I 647 I�� Zip ,90 4�7p Telephone `- APPLICANT'S NAME Last f fy j First L Applicant's Address Applicant's E-mail Address -.... City G.c+"_£- fffi State (-" Zip 13 I Telephone ,5"(mw `r'„��-- TLRWMK =/DESIGNER'SNAMEiG�2�� �r/q�� Lic. No. Last FirstArchitectJaress Architect/Designer's E-mail Address _. City !G'Y�'Tls'i.:j� - -_ State ------ State ��Q---- Zip ..q Telephone 'i1G �e/ 5;-,2"?X-4J ENGINEER'S NAME Last First Lic. No.F� Engineer's Address Engineer's E-mail Address City State F_7 Zip _ Telephone CONTRACTOR'S NAME/COMPANY Lic. No. Class Contractor's Address Contractor's E-mail Address f`f f�i- - _ �����—>`�i r�__�1 rr� - - - __ ._.,' �/'� " r /�1 �1 C�/�S • C��`�- City Le7. State ! ZIP ©/�j' Telephoner -- _I ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO. 26 l GRADING P/C FEE $ - PLANNING P/C FEE $ PLAN CHECK NO. ELEC/PLUM/MECH P/C FEE $ _ PLAN CHECK FEE $ DEVELOPMENT # TOTAL FEES PAID $