HomeMy WebLinkAboutX2012-1979 - Permit ApplicationComm] y_, Residential
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Worksheet for Building Combo Permit Application— 3i-f 6-0-idenroc( hv2
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
PBuilding cainage j Elec Mech v
[. Cu Yd Cut _ Cu tl ill
60 c - ----
Project Address (Not mailing address) Floor Suite No
- - 31-7 ___r04944A
Description of Work r
Used.
012 3 k h
NjW
(�I l fti
# Stories i # Units If Res)
y
_
Valuation $
5 L ®(7
Material/Labor 5
New/Add SF � - Remodel SF F— Gara e/New/Add F
g —
OWNER'S NAME Last �L/j6� First \1en
\ I
Owner's Address Owner's E-mail Address
City ��.,.. State, Zip��,� Telephone
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APPLICANT'S NAME Last y/ First
Applicant's Address Applicants E-mail Address y
City �— - State Zips Telephone'.._7/�..
ARCHITECT/DESIGNER'S NAME Last re 7_7First)I f� �l
�L-Oj�/Ef.� Lic, No.
Architect/Designer's Address Arch itect/Designer's E-mail Address
City rp - — —_ State I �' Zip � �� Telephone 5�..,.._ -cf,��
ENGINEER'S NAME Last, First 2� Lic. No.__7l
Engineer's Address. Engineer's E-mail Address
C_ - --- - ---- ------ ---
city . - _ — J Stale �Zip Telephone��,
CONTRACTOR'S NAME/COMPANY l_ �� �� Lic No. 1Class-zJ
Contractor's Address Contractor's E-mail Address
�`Jl_.._nvo. !avl4 57,. 12 CP 1-3V-/A9 i4 �
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City u"_5.✓ ! --._— _.----- — State �o^......_._ Zip --c) ;+Tr c---.l Telephone 31'_0 2'
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE: $ PLANNING P/C FEES PLAN CHECK NO.
ELEC/PLUM/MECFI P/C FEE $ PLAN CHECK FEE $ Aft I
WAIIIIII",*64t
DEVELOPMENT 4 - TOTAL FEES PAID $