HomeMy WebLinkAboutXR2022-3086 - Permit ApplicationR ip� Worksheet for Building.Combo Permit Application
r, Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
F—Building rGrading f—Drainage rElec FMech F—Plum Cu Yd Cut �; Cu Yd Fill
!!!
Project Address (Not mailing address) Floor Suite No
Description of Work
Use
NLA r�i= S�� t
# Stories'',, # Units (if Res)
Valuation
Material/Labor
New/Add SF Remodel SF Garage/New/Add
OWNER'S NAME Q� ^' I --
Last /�� First
Owner's Address O Owner's E-mail Address
City L........._ _�V --.-- -... State .�li1�r ZiP1 2„C��jS '.,. Telephone 2rh�2 '.3
APPLICANT'S NAME Last First
1�C- --- ---- --
Applicant's Address Applicant's E-mail Address
k �4a CpovioN -�n ___ ���s��t-1 ._ CS, i
City' .— 1 C State D ZIP 9� J v7. Telephone -j/_4
ARCHITECT/DESIGNER'S NAME Last First F_ Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
pity State —', Zip—, Telephone —
ENGINEER'S NAME Last y b First �A/6— Lic. No. S
J`
Engineer's Address Engineer's E-mail Address
City --� ..,�. _._.. _. State FZ Zip Q��� Telephone,�.r�6'oS'h VV
CONTRACTOR'S NAME/COMPANY Sf v-LIB(-NS k .. __-_ Lic. No. 3 7 Pj /� Class
Contractor's E-mail Address
Contractors Address,,,
re'- / l
City S y ,^ _ State Zip q�� -Telephone F, l(R
i— UT 1
ENERGY P/C FEE $ FIRE P/C FEE $ PERMIT NO. 2—
GRADING P/C FEE $ PLANNING P/C FEE $ PLAN CHECK NO. snGzSL'Z S�
ELEC/PLUM/MECH P/C FEES PLAN CHECK FEE $
DEVELOPMENT # TOTAL FEES PAID $