HomeMy WebLinkAboutX2012-2496 - Permit Application� P n "Ford F Worksheet for Building Combo Permit Application
r Comm'I r' Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
233 I I��i-Wre�
)"Building F_Grading F-Drainage [-.Elec F, Mech F_Plum Cu Yd Cut Cu Yd Fill v
Project Address (Not mailing address) Floor Suite No
_ 2331 � �fir�e r k�V) -
Description of Work
Use
0 M,3 +,c� KV J rocs MCAA tl�ed- eYlC k-DN'C VS' CIT1
# StoriesF # Units (if Res)[
Valuation $ -
Remodel SF Gara e/New/Add F�
New/Add SF� g
Y
Material/Labor Ilcl
OWNER'S NAME Last First y
Owner's Address Owner's E-mail Address
City State -'i Zip F- Telephone j LV 2,1 1- U53=D
APPLICANT'S NAME'
Last ..._aft- ..` _._..-...__... ! First C�.6J `tV0o,—._ __ _._...-
Applicant's Address Applicant's E-mail Address
City State F_ Zip i TelephoneLP5"1.,2LS19 7J�' L;2_
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip F Telephone
ENGINEER'S NAME L at-U } t _ _.-.- Lic. No.�-
: �.r�� 1`
Engineer's Address Engineer's E-mail Address
City State r Zlp� Telephoned
CONTRACTOR'S AME/COMPANY �� Lic. No. Class
� C
-
Contractor's Addres .. Contractor's E-mail Address��
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City FC;L,tI r_ �Yl� _- State Z,� Zip �."�I U _ Telephone '� J 1
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 FEES PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $