HomeMy WebLinkAboutX2019-2782 - Permit Application"P,rnt Farm ;i,� Worksheet for Building Combo permit Application MIN
Comm I jvFeadential City of Newport Beach - Building DivisionjR8j-ZRNOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL �,?Q��- 27$2
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Project Address (Not mailing address) Floor Suite No
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Description of Work
Use
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Valuation $T�o
Material/Labor'V
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OWNERSNAME Last First
Owner's Address Owner's E-mail Address
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APPLICANTSNAME LastS Q h, j First FjokkL,
Applicant's Address Applicant's E-mail Address
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ARpi1TECT/DESIGNERSNAME Last �✓oo y First �m
"' Lic. No.F_
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Address Architect/Designer's E-mail Address
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ENGINEERSNAME Last First7____ Uc. No.F
SEngineer's Address Engineer's E-mail Address
City 1 State Zip Telephone
CONTRACTORSNAME/COMPANYJpr,�'i1/p 'd_I'I$� Uc.No. �g3-CPP class
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Contractor's Address Contractor's E-mail A dress
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City �t Deis i Q h V1 _` 0 ( State I V� Zip I t) I Telephone /R3 &fs g 3 3 b�
ENERGY P/C FEE $ RF£P/CFEE$ PERMIT NO.
GRADING P/C FEE. $ PLANNING P/C FEE $ PLAN CHECK N0.
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $