HomeMy WebLinkAboutP2012-0322 - Permit ApplicationZN (Z- / /dj/2 <S l00�
P�L`f orn a Worksheet for Building Combo Permit Application
City of Newport Beach - Building Division _
Comm'I [— Residential nlnTG- of nru r l-IPRK FFP rAMF�Y TIME OF SUBMITTAL
f7Building r, Grading [,Drainage I1QAlec Mech rvi.nI Cu Yd CutCu Yd Fill
F -. --.. I _ _
Project Address (Not mailing address) Floor Suite No
Description of Work
Use
#Stories #Units (if Res)
J
,
__
Valuation $
New/Add SFF--, Remodel SF Garage/New/Add—„
_ _....__
Material/Labor
F
OWNER'S NAME Last l�tx plwLe, First
Owner's Address Owner's E-mail Address
City �`LLC.� --__ ---. ',, Statel, Zip q,(_d !. Telephone'���Y
APPLICANT'S NAME Last ¢1d✓ C£ v First fit'
Applicanfer Address Applicant's E-mail Address
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City "J ----------...---) State I ' Ll Zip ----1 Telephone 711_F5'li —
ARCHITECT/DESIGNER'S NAME Last First �', Lic. No. �l
Architect/Designer's Address Architect/Designer's E-mail Address
City State - Zip � -� TelephoneF_
ENGINEER'S NAME Last First Lic. No.��
Engineer's Address Engineer's E-mail Address
City State E77 Zip F _ Telephone—,
CONTRACTOR'SNAME/COMPANY Lic. No. �19�5'�Z, Class
Contractor's Address Contractor's E-mail Address
U_G SCI s
_._ _t2?)o - --- -
City /,�, -', State —� Zip . Z� � Telephone 7lC F IS _. g9V7
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ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO.
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $