HomeMy WebLinkAboutXR2023-0253 - Permit ApplicationCOmm'I [ Residential
Worksheet for Building .Combo Permit Application
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
[Building r Grading CDrainage r Eiec i- Mech j- Plum Cu
Project Address (Not mailing nrirlru %
of Work
New/AddSFF7-- Remodel SFF
OWNER'S NAME Last
14 vAR �0 (- Gr
Cu Yd Fill I_
Floor Suite No
Use
-- - — — # Stories # Units (if Res)F
Gara a/New/Add Valuation $
g �- Material/Labor FD D
First[
Owner's Address Owner's E-mail Address
------------
City
—,_ .,.� State �—
.._..__..._ -`� ZIP ��I -7 /, e- Te
APPLIGANT'S NAME
Last-Sice't7�`----------
Applicant's Address
L-t� a1'1-_ pr01��DN ti t r
City State
ArcGrn 1 tG I /DESIGNER'S NAME
Last
Architect/Designer's Address
City State
First
Applicant's E-mail Address
9 _
Telephone 7 [4
2.
First I Lic. No. �—
Architect/Designer's E-mail Address
ZIP F_- Telephoned -
ENGINEER'S NAME Last
_Lt1 �l - First fVC�
Engineer's Address Engineer's E-mail Address
Lic. No. -72. ig q
City ---- ---------------._ State /�(� -_-- ZIP � �— Telephone ��Gr h(7.2 6s�-b
CONTRACTOR'S NAME/COMPANY �1
_ Lic. No. _ f�� l'-{1��c,Cs t _ %[�(t(_7_ Class
Contractor's Address Contractor's E-mail Address
City State /� ZIP Telephone'
almanGT r/c rtt y
GRADING P/C FEE $
FIRE P/C FEE $
PLANNING P/C FEE $
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PERMIT NO. X P Ltn _ A 1 r
PLAN CHECK NO
ELEC/PLUM/MECH P/C FEE $ PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $