HomeMy WebLinkAboutXR2022-2387 - Permit ApplicationPrint Form
r Comm'I r Residential
Worksheet for Building Combo Permit Application Q4eEW 31
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEE DUE AT TIME OF SUBMITTAL"
F-Building F_ Grading F-Drainage FElec rMech
Plum Cu Yd Cut[ Cu Yd Fill
Project Address (Not mailing address)
Floor Suite No
y I a C O r i-//�N� �r� V-6
Description of Work
Use
re &/ k►'hi&n / 6a
bx-A!,s
#Stories #Units (if Res)
Valuation f
New/Add SFF Remodel SF S-�,' Garage/New/Add
Material/Labor[61000
OWNER'S NAME Last Cle
First /ray
7
Owner's Address
Owner's E-mail Address
Y-7 eii
d
Cit z... State i._..... o4 -
Y I r�
Zi Tele hone
P o2 P 03� 77�'-
APPLICANT'S NAME Last ( First /11 "q
J
Applicant's Address
Applicant's E-mail Address))
7a 4 C'0%,'!o/vv
"tlAo-yh�'G�
City Y /VI State I `n
Zip ga s Telephone tN .?q/,77�5_
ARCHITECT/DESIGNER'S NAME Last �—
First I Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City StateF_
Zip F Telephonel
ENGINEER'S NAME Last
First I Lic. No.l
Engineers Address
Engineer's E-mail Address
City I-- State F
Zip F TelephoneF�
CONTRACTOR'S NAME/COMPANY O
Ly Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City State F_
Zip r - Telephone—
ENERGY P/C FEE $ FIRE P/C FEE 8
' h
PERMIT NO. zzi 2M7
GRADING P/C FEE $ PLANNING P/C FEE $
PLAN CHECK NO.
ELEC/PLUM/MECH P/C FEE $
PLAN CHECK FEE $
DEVELOPMENT #
TOTAL FEES PAID $