HomeMy WebLinkAboutX2012-1878 - Permit ApplicationX,Coni F_ Residential
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Worksheet for Building Combo Permit Application 34, 1jeoPO(`T (Pjjwr
City of Newport Beach - Building Division
NOTE, PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
Building Grading F,Drainag r El c F_ Mach F_ Plum Cu Yd cut Cu Yd Fill
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Project Address (Not Mai lin ress) Floor Suite No
Description of Work
Use
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# Storie _ # Units (if Res)
uation $
Material/Lab l
New/Add SF7i Remodel SF�, Garage/New/Add
OWNER'S NAME: Last (SUN / i� First
Owner's Address Owner's E-mail Address
City F State I Zip �'�i Telephone ,
APPLICANT'S NAME Last II, First
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Applicant's Address Applicant's E-mail Address
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City�F i State 7 i Zip �a,�e �(�._-- Telephone—.7
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ARCHITECT/rEI�N R'S NAME Last 1* First ( ✓Z
�" � � li Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City �__---- State F777 Zip 17 -,-„ --, Telephoned -- !
ENGINEER'S NAME Last F First F777777 Lic. No
Engineer's Address Engineer's E-mail Address
City State State, Zlp .... 7elephoneF�_
CONTRACTOR'S NANAME/COMPANY n m�� Lic. No. Z ,Class
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Contractor's Address Contractor's E-mail Address
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(-P?/S)71- p %ItiSM
City ' V. --.-.- State .I Zip ... �'7 '. Telephone II.i�s `/� s.. 5T`Y
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ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
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GRADING P/C FEE $ _ PLANNING P/CFEE $ PLAN CHECK NO. OqS - OP 12 -
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $
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