HomeMy WebLinkAboutXR2022-3087 - Permit Application�r;" ' Worksheet 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 F-Grading F-Drainage [Elec F-Mech j-Plum CuvdCut F. CuvdFill F
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Project Address (Not mailing address) Floor Suite No
Description of Work
Use
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#Stones; #Units (if Res),
Valuation $
Material/Labor `d�
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New/Add SFF_— Remodel SF 7— Garage/New/Add F—
OWNER'S NAME Last ✓ v First
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Owner's Address 14t) Owner's E-mail Address
City State / (� , Zip F Telephone O' 4� 3 44
APPLICANT'S NAME Last t'i t First pn��
Applicant's Address Applicant's E-mail Address
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City A /n State Zip t�7DS_Telephone.-7/ I. ��-�^� _t ( P, i
ARCHITECT/DESIGNER'S NAME Last First �? Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City State—; Zip F____7 Telephone�—
ENGINEER'S NAME Last �/ I,n�, First', Lic. No. S.2 9
Engineer's Address Engineer's E-mail Address
City ��.�,� _ {�, - state r /� n Zip � Telephone 7'�2 (-y�
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CONTRACTOR'S NAME/'COMPANY d�La-Us t � /J,_ i Lic. No. r 177 4 Class
Con-ttractor's Address Contractor's E-mail Address
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CityFS_ (1 State Zipr �/OS Telephone �/ �� �, I 9
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ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO. ` a_-107iZ WL-7
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO.
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $