HomeMy WebLinkAboutXR2023-0259 - Permit ApplicationWorksheet for Building :Combo Permit Application rEW�ar
Comm'I Residential
City of Newport Beach - Building Division o a
[ NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL
py.
F-Building F_Grading CDrainage F_Elec 7Mach
(—Plum Cu Yd cut Cu Yd FillF
Project Address (Not mailing address)
Floor Suite No
Description of Work
Use
# Stories # Units (if Res)
Valuation $
Material/Labor V� i
New/Add SFF7_7 Remodel SF-7 Garage/New/Add F
OWNER'S NAME Last First v
Owner's Address
Owner's E-mail Address
y _, State
cityIC.
Zip P.. Telephone l]i.
APPLICANT'S NAME Last S rv� �� First
Applicant's Address -
Applicant's E-mail Address
���4 L GL�toN_ _:SC -
nLc�nlssw��11 �Go�C . N�� ;
City LS ,N ,N4,.--_____- State
Zip l_d e-,§- Telephone. /(.I,�g 119
ARCHITECT/DESIGNER'S NAME Last First F �—
Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
city -, _, State F
ZlP F Telephoned
ENGINEER'S NAME Last Y R p
- First A- jv� Lic. No.
Engineer's Address
Engineer's E-mail Address
City .. _. �/:, ._-. - State
Zip `"-1 D�" TelephoneFZilt-,
CONTRACTOR'S NAME/COMPANY Nt� tJs_ _ _ �,,,�
Lic. No. :7 qZ*L) Class
r� -- Co ate—--
Contractor's Address
Contractor's E-mail Address
City N!� N� State
Zip �9,70 —Telephone
ENERGY P/C FEE $ FIRE P/C FEE $
PERMIT NO. Z Ot- —UZS 1
GRADING P/C FEE $ PLANNING P/C FEE $
PLAN CHECK NO. MC iU j 3 — U11 4
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $