HomeMy WebLinkAboutX2021-0798 - Permit ApplicationWorksheet for Building Combo Permit AApp5Gatlon ro4° Poh
r City of Newport Beach - Building Dit,isiono �* C9_20'z � k
�; Comm'I FResidential 4DV
wm -F PI AN (:HECK FEE DUE AT TIME OE SUBMITTAL
KIBuild ing CI Grading F]Dralnage X Elec Mach �] Plum cu Yd CutE — ce 'd Fill
l LLL J
FllllooDr Suite No
�Tresje�t Address (Next m aifi tg a€ dress)
PIZ_
Description of Work
Use �-� ()/r6It'fK
# Stories # Units cif Res) -i
i
Valuation$
New/Add SF�� Remodel SF 4/ii Garage/New/Add L
Material/Labor—�
OWNER'S NAME Last � . IJ✓I% �_ First
Owner's Address Owner's E-mail Address
d O V� I �I—
.City ���/ State ZipTelephone" !�U
APPLICANT'S NAME Last � First L -K
Applicant's Address App}laamrs E -maul Address
City �j�/ State Zlp 1)/�lG� Telephone �p`Z
Llc. No.
A.RCHFFECT/DE'SIGNER'S NAM[:.�—+— A. G # /I /y��J_I
Last First
Archttact/Deslgner's Address Arch ltect/Deslgnars E-mail Address ly
City � I��✓�i�([ � State ii � _ ZIP C�Z' %(%— Telephoner��
ENGINEER'S NAMES Last [ First Llc. No.
Engineer's Address Engineer's E -mall Address
City � State C� zip Telephone ,
lass
CONTRACTOR'S NAME/COMPANY LIc.No. CEC
Contractoorr'Is 'Address /A Contractor's E-mail Address j
(j"T_�( tfi X70. A\3e (Ayi t�" lL. .. -_�t^ a e( OL �GC��.l.1
l�
city F. CU c V cPdG.�_� State G� ] Zip �2... Telephone 71l} _�tJ9 �7
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO.
GRADING P/C FEE $ _ PLANNING P/C FEE $ PLAN CHECK N
ELEC/PLUM/Iv1ECH P/C FEE $ PLAN CHECK FEE $
l9
T