HomeMy WebLinkAboutX2019-2748 - Permit ApplicationWorksheet for Building Combo Permit Application'
MIAMI City of Newport Beach - Building Department p
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1. Project Address (Not mailing address) Floor
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Tenant Name(if
2. Description of Work
# Units (if Residential)
Use
Suite No
..........
Exist House SF Demo House SFValuation $ /
F77Add/Reconstruct House SF <
Exist Gar SF Demo Garage SF Add/Reconstruct Garage SF # Stories JF7
'_ TOTAL HOUSE SIF Cu Yd Cut
New (y Add F—, Alter f' ;Demo -- --- —
TOTAL GARAGE SF Cu Yd Fill I
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3. Owner's Name Last�4 LFirst pN
Owner's Address
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city Po State
Owner's E-mail Address
Zip TelephoneF94/) 5/z3..a.`'z.... cP
F 4. Arch itect/Designer's Name Last �(/ ?� First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
CityState F777 ZipF... Telephone��W
r 5. Engineer's Name Last �_® First ��®®.' Lic. No.
Engineer's Address
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City F State
Engineer's E-mail Address
Zip Telephone
[—,.6. Contractor's Name Last �eF,,y�t FlrstLic. No. Class�C y
Contractor's Address
2 z LI Ca
City S n^ State
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Contractor's E-mail Address
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Zip `��p� Telephone q� Or� -L
OFFICE USE ONLY ENERGY P/C FEE $ PERMIT NO.XZ-MI-0-7
GRADING P/C FEE $ PLAN CHECK NO.
Rev 1/18/07 ELEC/MECH/PLUM P/C PLAN CHECK FEE $