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HomeMy WebLinkAboutX2017-0656 - Permit Application (2)PnntFo6m ]Worksheet for Building Combo Permit Application 555-70X2011- 0656 Comm I Residential City of Newport Beach -Building Division' NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL uilding Grading F`Drainage F_ Elec r Mech m cu vd Cut \ so Cu Yd Fillt \O '35�-F Project Address (Not mailing address) ©,'Ot 1-t Floor suite No 1215 E. bca6aa \�c . I Description of Work Use SFR nemeGSh a+n ex�gtin� 3F'R- t c%\a�ned. �argeJ. ane% carts�+vcti a t�ew 3 - # Stories # Units (if Resfi g" gp� w q'c6>,ched 3 -car �Q dM� (cc� okeckG I L� Valuation $ N-eew,/Add SF y`1`iq Remodel SF F Garage/New/Add G`F# 830 060 Material/Labor OWNER'S NAME4hw \ar Last._ _.. -._ _., First Tye,,, t.+Am,�tr\y. (Tysaa.��•,alyT�tl .. Owner's Address Owner's E-mail Address Z031 `l -►o o\d Ne"pw-F 01vd. �mql\ @ i �t _ o to G. GCm City State I r r Zip Telephone (_;- lo'AS -S8 S+ APPLICANT'S NAME Last Qjgra First Marhr Applicant's Address Applicant's E-mail Address t{lO O\c� 1Jcwp5x� 'e$\vd ew.d\@ hja-'mc. cnm city H_4b,* Fyeac)r% State A Zip 'k2bto3 Telephone(Tvo ,*s _"S' ARCHITECT/DESIGNER'S NAME Last 'Scxneti� First Lic. No. 4,i6\2 Architect/Designer's Address Architect/Designer's E-mail Address t}'>O. o\A 1Sc3?Ex•f evnalk@ kn)q-.1`nC. ccvF+.. City �k ( �4. State Lda. N��, _ �2L43 Telephone zip ojR)1okS-StSS ENGINEER'S NAME Last ['ethlm� First P,t \,r Lic. No. C-1819 Engineer's Address Engineer's E-mail Address 23112 P\azt, (�otr�e �Jv:ve �...#�1'i5 ''.,. gYnkrQatoresi�vciare.acnn :. City I -"�""a\M�' State Gt4 Zip qZ 3 Telephone °I i9� 9S`i-llti j CONTRACTOR'S NAME/COMPANY r �/ Lic. No. y61rs3 Class Contractor's Address Contractor's E-mail Address 700 L'A•?+/�rYo✓ ✓�f/C Ad/jYC J1/E C{ �O ✓! f//FtCN7� i GNNj�?UOY City State G'A Zip V2G2S Telephone9'/Z/s 723 —G y ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO. GRADING P/C FEE $ VG %C, PLANNING P/C FEE $ r1 PLAN CHECK NO. 0 ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $ PA 7 O DEVELOPMENT # TOTAL FEES PAID $ Q O(tl