HomeMy WebLinkAboutX2012-2655 - Permit Application'11N2012.-24,�55
arnt" Worksheet for Building Combo Permit Application I�
9 pp 1 "L� �� S`t
n Comm" jesidentiaL, City of Newport Beach - Building Division (1 5 Y
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL t iz,/ rv/
_.f-l13ul1dirr) ,I7 Grarlina C P.rainage F-Flec. _`'Mach F'Plitm .r„v cuvI _. : r v p,a,F v
Project Address (Not mailing address) Floor Suite No
Description of Work rj
Use I r/
v\jc,, rZ-e lac?
# Stories #Units (if Res)
Valuation $ -
Material/Labor
----
New/Add SF� Remodel SF F7-- Garage/New/Add -
-
OWNER'S NAME Last P v2 y First
I�
Owner's Address Owner's E-mail Address
City State iia�........ Zip 2 .11J-3 Telephone IV 7qy--./4�(?
NAMLast First
rPLICANT'S
icaess Applicant's E-mail Address
-45 �p
City State �i Zip �—� Telephone
ARCHITECT/DESIGNER'S NAME Lic. No. r_
Last F— , First ��
Architect/Designer's Address Architect/Designer's E-mail Address
City State - Zip Telephoned
---
ENGINEER'S NAME Last First Lic, No F
Engineer's Address Engineer's E-mail Address
City— State F i Zip F— Telephone��
�— — Lic. No.
CONTRACTOR'S NAME/COMPANY Class
L l &P Ulli t Jt,, Pro. S. F Is,>,
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Contractor's Address Contractor's E-mail Address
--771 C_G bea LN- 33 _
City JJl21C...._ VGt�_. ------.....--- -' State ��_---- Zip --_-/ 3prP1'� .i Telephone �'(K9•C/(0 (if.1
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO. &
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK No. �C11v at, xz,
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $