HomeMy WebLinkAboutX2019-1553 - Permit ApplicationPrint Form
r Comm'I X Residential
Worksheet for Building Combo Permit Application 0012 -City of Newport Beach - Building Division(S3tijNOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
Building r Grading rDrainage gElec rMech r Plum cu Yd Cut Cu Yd Fill
Project Address (Not mailing address)
Floor Suite No
5a3 -5ANTf} f}Nh 4VtF .
F
Description of Work
Use
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9FM0VC .� /�EP6 41ce � V/eyWi4LtAl450
# StoriesF— # Units (if Res)-
,005 7n Gth�'e9� �IR�:
Valuation $ Op.
Material/Labor 20� �%�, --
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New/Add SF I "� " Remodel SF l f
Garage/New/Add
OWNERS NAME Last &VDER50/v
First 1 /!`�6M,,9.S
Owner's Address
Owners E-mail Address
300 _s• fi*-63,w GG D. /000 bug -z (2 vrte. cove
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City 41-v- -HE•l� _ State C Zip 2 g0S' Telephone ,7fq, +q -/%.//
APPLICANT'S NAME Last De7YGN�U.SeAl First 7c74f0Wft/
Applicant's Address
Applicant's E-mail Address
P. o. (3o�c 3381
den�h �vs�n crc�sl ex�v'erne.con�
LC
City WwpoA7- H State ��
�Lc�
ZipF9,726 57 Telephone -7 2SSo
ARCHITECT/DESIGNER'S NAME Last - 14,28 J
�ONGj- U/q '/U First /�7 /;/ W Lic. No.
Architect/Designers Address
Architect/Designer's E-mail Address
f o.%O 3381
x
L
cle �a1USC�i�`�IS�eXct^erne•cairrL
-_
City /► kw10D2J �3C/9Cf� State F5�—
Zip Gf 9, Telephone 9ef� G) , •/Z 35-, ;;Z,rg0
ENGINEER'S NAME Last 1 � G H/
1
First sH(h%/pj Lic. No.
Engineers Address
Engineers E-mail Address
1112-E. CY1g,,0 'J&V fj vtt . -#'O/
City QiQ/4N�E' State �
Zip 8'w6 Telephone F//.2O
9�
CONTRACTOR'S NAME/COMPANY (Wlrlq�Z- CO/USTiEJUG%%d Uc. No. 8" jClassF
Contractors Address
Contractors E-mail Address
City � � //vs %J ,�Q State
, �- \
Zip 9268'3 Telephone 7-/ 4-- 73 3 2 ,
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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. Q jZ Zig
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $ 35 .ry .. %
DEVELOPMENT #
TOTAL FEES PAID $