HomeMy WebLinkAboutXR2023-0251 - Permit Application (3)[' COmm'I Residential
Worksheet for Building .Combo Permit Application
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
I-_,rsunding I Grading r-Drainage r-Elec
(- Mach i- Plum Cu vd cut
Project Address (Not mailing address)
--s-_S W, s Gr
Description of Work
New/Add SFr' Remodel SF
OWNER'S NAME Last
Cu Yd Fill I_ ---
Floor Suite Nc
I --
Use r—
-- #Stories#Units (if Resfii
Garage/New/Add F Valuation $ FDO
oOMaterial/Labo
First O
Owner's Address
city
State
—1 1u„nrv1 aNAMt
Last
Applicant's Address
pplican'sAddress
City CjtR State �—
.. ...�rmv�prt J 1YAlY1C
Last
Architect/Designer's Address
177
- --
City State F_
Owner's E-mail Address
Zip
First
Applicant's E-mail Address
W64-5.S1"�t. uJ J b�G. {U s. T
Zip - 4%-�?.o5_ Telephone.--.-1_�." i s 9 1
First I Lic. No. r--
Architect/Designer's E-mail Address
- ---
Zlp - Telephone—
LrvvinttiCb NAME Last
X _ First ( 1 Lic. No.
Engineer's Address
Engineer's E-mail Address
4 4 S
-- - ---
City �Zipp ------ - -- -.
---A _ nLL__.._ State �i'n l`�,71i5 p / ...--- -- --
---- Telephone(- Kr I C)_S (
CONTRACTOR'S NAME/COMPANY
yw._T} 1 L — Lic. No. ��%(t4 D Class
�w i __
Contractor's Address ---
Fe
Contractor's E-mail Address
city /� p----------------- -._
- -- ... 1 ---- State �!_T_ Zip 1 �% b Telephone 76S319 I 19 /
FIRE P/C FEE $ �/p
GRADING P/C FEE $ PERMIT NO. 1�'. -0ZSZ
PLANNING P/C FEE $ PLAN CHECK NO. qC U LS_ pl,-jy
ELEC/PLUM/MECH P/C FEE $
DEVELOPMENT # PLAN CHECK FEE $
TOTAL FEES PAID R