HomeMy WebLinkAboutXR2022-3089 - Permit ApplicationWorksheet for Building.Combo Permit Application
F- Comm'I (— Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL_
',Building r Grading F-Drainage F Elec [ Mach F- Plum Cu yd Cut Cu Yd Fill F
Project Address (Not mailing address) Floor Suite No
Description of Work
use F_
# Storiesr2-- #Units (if Res)r!,
Valuation $ Fb-,
New/Add SFr— RemodelSFFGarage/New/Add�Material/Labor-�•
OWNER'S NAME Last �IC�]P/POt�(�L��i' First
- - -- — -
Owner's Address Owner's E-mail Address
City N State Zip Telephone-R�� �L4
APPLICANT'S NAME LastCTIr,FirstL-
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Applicants Address Applicant's E-mail Address
'f/&dss 'c-k-t* Goy, Nt i
City _ s � State . Zip Tf 7oYTelephone J,� ?
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ARCHITECT/DESIGNER'S NAME Last First F Lic. No. r— ',
ArchitectlDesigner's Address Architect/Designer's E-mail Address
City ---, __-_-' State r ', Zip —' Telephone—'
ENGINEER'S NAME Last �/ t �v First �� Lic. No.�
Engineer's Address Engineer's E-mail Address
city � _,.. State Zip ( Telephone �� L_,dS-7%i
CONTRACTOR'S NAME/COMPANY p/CytJ� rt k �S t_ Lic. No. j %ly/� j� ! Class j�
Contractor's Address Contractor's E-mail Address
CityNt>/�t�/„Y State' Zip ��?D—Telephone a�LF S t�
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 $