HomeMy WebLinkAboutX2013-2255 - Permit Application%Font:;;;
Please print 3 copies
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Worksheet for Building Combo Permit Application
MettA_5 City of Newport Beach - Building Department
Building j- Grading 00rainage �Elec Mech xpluma% `1, V`
1. Project Address (Not mailing address)
Tenant Name(if Applicable) I[wItz
2. Description of Work
............ ... ..... .
Exist House SF ti Demo House SF F777 Add/Reconstruct House SF (Pi�
Exist Gar SF �v Demo Garage SF F Add/Reconstruct Garage SF j'
TOTAL HOUSE SIF
(-"' New ' Addi Alter r7Demo -- ---
It \ TOTAL GARAGE SF 3
Floor Suite No
® F77F77
# Units (if Residential)
Valuation$ �2L�
Ak_ Stories Z
Cu Yd Cut
Cu Yd Fill
Engineer's Address
Ito( e, ;2�axvw
City
F-, 6. Contractor's Name Last
T -e IL-7)—
State
Contractor's Address
City 14 State—; ......... C
Engineer's E-mail Address
p S Telephone 8 tp �L) C (Qui
............... ..........71 __....
N, Lic. No. S3((1 Class
Contractor's E-mail Address
Zip %�dq Telephon I q7) 35s :t 101
OFFICE USE ONLY ENERGY P/C FEE $ g-2 �- 4PERMIT NO. 100
IS-�
cs,3i.l17
GRADING P/C FEE $ PLAN CHECK NO. z a '
Rev 1/18/07 ELEC/MECH/PLUM P/C PLAN CHECK FEE $