HomeMy WebLinkAboutX2012-2115 - Permit ApplicationPrint Form_
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Worksheet for Building Combo Permit Application
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address)
Floor Suite No
Description of Work
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Use
# Stories[— # Units (if Res)[—
Valuation $
Material/LaborIt?
New/Add SF1 Remodel SFF_uy
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Garage/New/AddI—
OWNER'S NAME Last Pt
Firstu� iT
Address
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Owner's E-mail Address
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City 1 04CAA f�/� u � State � Zip r� Telephone
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APPLICANT'S NAME Last #A� Z�A15S
First t��eeJ/ Y
Applicant's Addressp
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Applicant's E-mail Address
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City - State
Zip 1�� Telephone
ARCHITECT/DESIGNER'S NAME��
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First F Lic. No.
Architect/Designer's Address N/
Architect/Designer's E-mail Address
City F State F
Zip Telephone
ENGINEER'S NAME L st I
First Lic. Nc
Engineer's Address
Engineer's E-mail Address
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City State F
Zip f 0_-..--- TelephoneF
CONTRACTOR'S NAME/COMPANY Lic. No. i Class
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Contractor's Address
Contractor's E-mail Address
City State
Zip Telephone
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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.
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT#
TOTAL FEES PAID $
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