HomeMy WebLinkAboutXR2022-3088 - Permit Applicationrt Worksheet for Building Combo Permit Application
City of Newport Beach - Building Division
r' Comm'I: Residential NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
[;Building rGrading rDrainage [Elec Mech Plum CuvdCut cuvdFill I
Project Address (Not mailing address) Floor Suite No
Description of Work
Use F
#StoriesF, # Units (if Res)F_
Valuation $ I J 4
Material/Labor 17t
New/Add SF Remodel SF F —' Garage/New/Add �—
OWNER'S NAME Last % l G rst
Owner's Address l 1 Owner's E-mail Address
City - _ State Zip�`l Telephone t�—
1
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City -, State I Zip 9r1-7O_S_- Telephone 7 f/4
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
- — ---- - -
City ;. State F Zip �-- Telephone—
ENGINEER'S NAME Last First j� Lic. No.
Engineer's Address Engineer's E-mail Address
\ / Telephone ///
City Sl�.� �(\ C y ^ �y State / r� — Zip !I %OS I �( D
IEICYOvMf �1
CONTRAtC"TiOvR'S NCAM P'ANY -! Lic. No. 3'/q�rj ClassE
Contractor's Address Contractor's E-mail Address
DA `a t:TL - - -- --
City FF State 0 Zip;? DSO Telephone
ENERGY P/C FEE $
FIRE P/C FEE $
GRADING P/C FEE $ PLANNING P/C FEE $
ELEC/PLUM/MECH P/C FEE $
PERMIT NO.
xQ4,0�-Z_-W6
PLAN CHECK NO.
PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $