HomeMy WebLinkAboutX2012-1701 - Permit Application(2-)- x201z i--ol
Print Form Worksheet for Building Combo Permit Application �� S urv+tm�iJk
Comm' Residential City of Newport Bich - Building Division n g
NOTE: PLAN_GHECK PEE DUE AT TJME OF SUBMITTAL oa�
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Project Address (Not mailing address) Floor Suite No
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Description of Work
Use
#Stories #Units (if Res)
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Valuatiol,
Material Labor
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New/Add SF� Remodel SF� Garage/New/Add I
OWNER'S NAME Last e 6Yo T, i- S First �—✓ rC � 1 ' `QMCO
Owner's Address q y �Owner's E-mail Address
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City ��� State" 01 Z 6&3
ZIP
j t Telephone
APPLICANT'S NAME Last ��S,�GIt-i First L12{ecl�
IApplicants Addresss,� Applicant's E-mail Address
City I VDWatq�,_4 l State F c, -- Zip F Telephone
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ARCHITECT/DESIGNER'S NAME Last First r Lic. No. F_-
Architect/Designer's Address Architect/Designer's E-mail Address
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City F— State i Zip �� TelephoneF�
ENGINEER'S NAME Last F_ First Lic. No.[ —
Engineer's Address Engineer's E-mail Address
City w State Zip Telephone[
CONTRACTOR'S NAME/COMPANY �/ S Ca�+s `�Z� Lic. No. (� � 2 � S Class F
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Contractor's Address Contractor's E-mail Address
City State — Zip iq l Telephone ] �� j(��� Z
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ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO. �� /
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO. 2 ��
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $