HomeMy WebLinkAboutX2012-2176 - Permit ApplicationWorksheet for Building Combo Permit Application
no City of Newport Beach - Building Department
Please print 3 copies Kull- z IV
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I. Project Address (Not mailing address) Floor Suite No
# Units (if Residential)
Tenqrlt,Name(if Applicable)
2. Descriptidn of Work Use
Extg Building I.SF Demo Building SF Add/Reconstruct Bldg SF .., F - - "
Demo Garage sf
Extg Gar sf Add/Reconstruct Garage sf Stories F777
New Add 17. Alter F-.Demo TOTAL BLDG SF Cu Yd Cut
TOTAL GARAGE SF Cu Yd Fill F�N�.',
3_._0wn6qs Name Last First
Owner's Address owner's E-mail Address
7.rt—
FW
State zip Telephone
City Fq
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EO�.,�'s�-N.M. Last Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City FTP�l� xlState Zip,
5. Engineer's Name Last First
Engipneer's Address Engineer's E-mail Address
City State Zip
,7 . Telepho
zip
F- 6. Contractor's Name Last
Contractor's Address
� State F Zip
City �
First I Vt, jL,1l_ Lic. No.
0
0
Contractors E-mail Addr
Lic. No.
ClassF777
M749"MM
PERMIT NO.
0 F1 SE ONLY ENERGYIP/CFEE$ PERN 15 11 -
G(A71N( /C FEES ;95t�EE'1$ PLAN CHECK NO.
P/C FEE 35 PLAN CHECK FEE $
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