HomeMy WebLinkAboutX2018-3144 - Permit Application�2o�-moi titi
Print Form / or heet for Building (:ombo Permit Application
r Comm'I Residential City of Newport Beach - Building Division
OTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) Floor Suite No
Description of Work
Use
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r vn, t 1 i S � 6 7 # Stories # Units (if Res)
1 �5 t�1 h G f7 ! Valuation $
New d SF Remodel SF a
V Garage/Ne _Add L�(�p Material/Labor �_;.
OWNER'S NAME Last First-
Owners Address Owners E-mail Address�� 1
City/ -M tr -a % State �— Zip z ( Telephone Qf f
APPLICANT'S NAME Last
Applicant's Address
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ARCHITECT/DESIGNER'S NAME Last
Architect/Designers Address
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city
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ENGINEER'S NAME
Engineer's Address
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Last j Y/464(
FirsttCll
Applicant's E-mail Address
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Zip g v& TelephoneFM 396- t7,c / /
First Lic. No. F_
Architect/Designer's E-mail Address
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Zip 2%0I Telephone /4 70/ 9!573'?
ln{�� First �f�� t Lic. No.(1?� 4 32a_
u E gineers E-mail Address
State
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Zip Z Jis�v Telephone %dq c?q7_ ?/xp
CONTRACTOR'SNAME/COMPANY RL (0 tAC—jjt)Q Lic. No. S3-pgoq Class
Contractor's Address /
City 5&,*TA- AmA State FCA
Contractors E-mail Address
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ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
�RADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO.
LEC/PLUM/MECH P/C FEES PLAN CHECK FEE $
DEVELOPMENT # ",J7 TOTAL FEES PAID $