HomeMy WebLinkAboutF2022-0442 - Permit ApplicationvvorKsneet ror it-irerermit Application Fe
Print Form
2-
Associated of Newport Beach - Building Division`
Please print 3 copies (� Z
Associated Building Permit # _ ire Sprinkler [ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name # Units �I
�i/< ,�� �- �4. J�
2. Description of Work
Use
Valuation $
fgccrfP 0. ✓I'�/'�f5 I ' of O`t' p
Extg Sq Ft � New/Added Sq Ft �Total Sq Ft� �
# Stories L"_I
[' New ❑ Add ;5�' Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name L3sst, ��r OFirst Dc:v7w III W
Owner's Address
Owner's E-mail Address
l �it��oer_ S
cicf�'�eplot®cc�'on ge/ Co/� I
City ._--. !' .�, �' State j
Zip. Telephone 7(y-.-�W_3_ej — C51gC/
F74. Architect/Designer's Name Last First . Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City L 1 State F JI
Zip �i Telephone
5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City -_ State F7777
Zip [7777�7 Telephoned
6. Contractor's Name Last �Qf J)V
f
First Lic No. s _a,--ClassF"
Contractor's Address
Contractor's E-mail Address
City n2 _WC e,l�x State '
Zip gaGss Telephone %/y jar Ley
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $