HomeMy WebLinkAboutX2012-2173 - Permit Applicationx za 1z-4 3
35`1 Old
MrnEesr:..?i Worksheet for Building Combo Permit Application
F-1 Comm'I F-I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
F-iBuilding r- Grading
F-Drainage f-,Elec r'"Mech r Plum CuYdCut l CuYdFill
Project Address (Not mailing address) Floor Suite No
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Description of Work
Use F
Nr; W S'tyrd
# Stories # Units (if Res)
Valuation $
Material/Labor
New/Add SF
Remodel SF Garage/New/Add
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
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City Ln .tNxl Hr+-ti5
_.-_. State CA..., Zip °I? 3. Telephone /`f___6�6 5y,S4:7
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
---------------
City
! State � Zip F7 Telephoned
_
ARCHITECT/DESIGNER'S NAME F Lic. No.
Last i First
Architect/Designer's Address
Architect/Designer's E-mail Address
I
City r _
State Zip i Telephone
! F
ENGINEER'S NAME
Last First Lic. No
Engineer's Address
Engineer's E-mail Address
City -
State �—; Zip Telephoned
CONTRACTOR'S NAME/COMPANY ��F/�le�T �y�rC Lic. No.®it5 Class (
Contractor's Address
Contractor's E-mail Address
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City 8-LFGc,cd.`r`2---
State , (D Telephone S")) 66_ bE,Fj
-' G./�-_ Zip
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 $