HomeMy WebLinkAboutXR2023-0249 - Permit ApplicationWorksheet for Building Combo Permit Application ��ar
[ City of Newport Beach - Building Division
Comm'] [ Residential
NOTE: PLAN CHECK FEE DUE AT TIMF OF st IRMITTAI
[Building [Grading [Drainage [Elec [Mech [Plum Cu Yd Cutl Cu Yd Fill
Project Address (Not mailing address)
Floor Suite No
_i _ ICrr�.2��� G-r
Description of Work
Use I
n
# StoriesF # Units (if Res)
Valuation $ Material/Labor �Q r� � (7
New/Add SFI— Remodel SF F—
Garage/New/Add r
OWNER'S NAME Last First �}p�
Owner's Address
Owner's E-mail Address
p
City Q>State 2 �� ZiP R Telephone _ - --6G3-- 44�I-61 744_D2
APPLICANT'S NAME Last
First
Applicants Address
Applicant's E-mail Address
City . _ ,(a -- State
zip -'-1.7--iv_s _: Telephone l l
ARCHITECT/DESIGNER'S NAME Last
First Lic. No. �—
ArchitecUDesigner's Address -
Architect/Designer's E-mail Address
City State
Zip F— Telephone
ENGINEER'S NAME Last
�I -mod- __ - _
First Lic. No. , 9
-_- Q_1.1�J✓Is�-._�
Engineer's Address
_-��---
Engineers E-mail Address
City PVll�ik f +YVo'- --- State I(�_±
Zip t -�bS_ Telephone 1 tF- 6PJZ 0-vi a
CONTRACTOR'S NAME/COMPANY Ytt eDUSI� Lic. No. a7Lr(.�jClass�
Contractors Address
Contractor's E-mail Address
City (%f f-�(� (��-�- -- State �� I�^
-- -- -- ------------ ---/-- --------- --
ZiPF9a Telephone fffi
ENERGY P/C FEE $ FIRE P/C FEE $
PERMIT NO. Xgjon_ C �
GRADING P/C FEE $ PLANNING P/C FEE $
PLAN CHECK NO. _ p(q�
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $