HomeMy WebLinkAboutX2010-2377 - Permit ApplicationWorksheet for Building Combo Permit Application
Print Form City of Newport Beach - Building Department
Please print 3 copies
F-Building1 Grading ,Drainage F Elec F Mech j— Plum
1. Project Address I
Tenant Name(if Applicable)
2. Description of Work
add
Extg Building SF F_
Demo Building SF F_' Add/Reconstruct Bldg SF F
Extg Gar sf r Demo Garage sf F Add/Reconstruct Garage sf I
TOTAL BLDG SF
(—I New j Add r— Alter (—Demo
TOTAL GARAGE SF
r.hnr4 Annrnnriafo Rnv fnr Annlirnnf
Floor Suite No
# Units (if Residential) F--
Use _.. _..
Valuation $
# Stories
Cu Yd Cut
Cu Yd Fill I
F 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City _
State F_. Zip Telephoned
F 4. Arch itect/Des ig ne r's Name Last
FirstF—LicNo.�mm
Architect/Designer's Address_
Architect/Designer's E-mail Address
City I --� ',.
State F_____W_Y Zip I Telephoned
5. Engineer's Name Last
First Lic No..
Engineer's Address
Engineer's E-mail Address
City _..... _...
State F_ Zip F— TelephonelNm_____..:... _ ...
rT6. ontractor'sName LastFW__��v�y Fvst��j ,� S Lic. No. '7'jl5y6Class 9
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Contractor's Address
Contractor's E-mail Address
City �c«�-„-S '� `�,`�,L
State Zip j��S TelephoneC��/
I
OFFICE USE ONLY ENERGY P/C FEE $
1 -3) - �� PERMIT NO.
GRADING P/C FEE $
FIRE P/C FEE $ s+ PLAN CHECK NO.
Rev4/16109 ELEC/MECH/PLUM P/C FEES
PLAN CHECK FEE $