HomeMy WebLinkAboutX2020-2390 - Permit ApplicationPrint Form Worksheet for Building Combo Permit Application o��EWPO
F Comm'I I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL �St FONN�
,`Building jGrading F-Drainage [! Elec r Mech 7 lum Cu Yd Cut CuYd Fill
Project Address (Not mailing address) Floor Suite No
_.
AjewPort _cmei- F�
Description of Work
Use
lVlfe�,'ioY Pewtod 1! j .e Tiles&t3 ba�l�l-�v�yls
# Stories, # Units (if Res)F
p-k walls _
Valuation $
New/Add SF Remodel SF Garage/New/Add F_ Material/Labor
OWNER'S NAME ll _+
Last First
1.1 �h l�
Owner's Address Owner's E-mail Address
Zip qqZ S'- Telephone
City /V7od'� C�`wt State - 1
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
.........
State Zip
F777City
....................... ......... ......... ......... ......... ......... ... . ................... _
�, Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip Telephone
ENGINEER'S NAME Last
r
First Lic. No.1
Engineer's Address
Engineer's E-mail Address
City
StateF777 Zip
Telephone
.. .m_..... ....................... .
CONTRACTOR'S NAME/COMPANY
Y�t7 Lic. No. ��� Class
LA............ C
Contractor's Address
Contractor's E-mail Address
-/3 ��7
_ � 4�er AJ.Q ��-
t- U_dd i/�_ �C
j
i�hn...�t �t'X. �.. �%G � �o ' Cn"in....... ....._i
City
State Zip
..............
91 %o � Telephone
ENERGY P/C FEE $
FIRE P/C FEE $
PERMIT NO.
GRADING P/C FEE $
PLANNING P/C FEE $
PLAN CHECK NO. . 2
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $