HomeMy WebLinkAboutX2021-2849 - Permit Application?Efrvogr
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Worksheet for Building Combo Permit Application U
Pri t Forrn City of Newport Beach - Building Department 1 I LZ
Please print 3 copies
[Building ❑Grading ❑Drainage
Elec ❑ Mech Plum
Floor Suite No
1. Project Address (Not mailing address) I F
22 Dk AT 0 3 b 5
I� # nit(if Residential)
Tenant Name(if Applicable)
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2. Description of Work
t0i N �E� sF�� o00 oao
A nn p(— _—_� Valuation $ /
Extg Building SF C* Demo Building SF AddlReconstruct Bldg SF
#Stories C,
Extg Gar sf z Sl Demo Garage sf Add/Reconstruct Garage sf Q�
TOTAL BLDG SF �SZZ I Cu Yd Cut=
Ell New Add [✓Alter F4: emo cuYd Fill LIB
J, � 1-7 AD 5 TOTAL GARAGE SF 9 5 LLJJ
Check A ro riate Box for ilicant
First --
❑ 3. Owner's Name Last
wner's Address
Owner's E-mail Address
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city
State I Zip �%�6Q Telephone 71 _,,/ Z- Z -%
S. N� First Lic0.
J
F] 4. ArchitectlDesigner's Name Last
Architect/Designer's E-mail Address
Architect/Designer's Address
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r� �� �j,�� State /� Zip Telephone
City TvOT("h U_r �J �Lti L ' Z�� f
it First f�l-qLic. No. G']g
❑ 5. Engineer's Name Last 56 �_�_ — _
Engineers E-mail Address
Engineers Address
9 i
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-- - Zip //����//z Telephone���j•9�y-/vC��
city l V { f 1U,5 I State Cf) LGrL� J_
� tp� Lic No. Class � .
-r-� �,,/���, First ���
F_ 6. Contractors Name Last 4437 _7Jr�-ZN_- -I 1 t'n- -__ -
Contractor's E-mail Address
Contractor's Address
'3(25 AW�_�ldw-G s -
/'� n I Zip �L(pTelephone
State �f-y -- -_-- --
City _ -� - - - --
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OFFICE USE ONLY ENERGY PIC FEE $
GRADING P/C FEE$ --FIRE PIC FEE $
PERMIT NO. n r-
PLAN CHECK NO.
PLAN CHECK FEE $
ELEC/MECH/PLUM P/C FEE $