HomeMy WebLinkAboutX2019-1169 - Permit Applicationat
Pflnt Form
please print 3 copies
Associated Building Permit #
t, project Address
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phton�Perim
Worksheet for
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Division�B�Z
City of Newport Beach -Building go jq
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Sprinkler Fire Alarm ❑
Fire Misc
Fire Sp Sul
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Floor
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# Units
Tenant Name -- Use
2. Description of Work n vI �, \
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--- — r— I Total Sq Ft
New/Added Sq Ft �_J #Stories �\
Extg Sq Ft
❑ ❑
Alter Demo
❑ New Add \
Check Appropriate Box for App
IicantlNotification �
Last First�—
g, owner's Name Lasowner's E-mail Ad ress
owner's Address
Telephoned
Zip 1�
—_ — State No.
City _ _ _ _ _ .. - First 01
ner's Name Last _�
�� 4. ArchitectlDesig Architect/Designer's E-mail Address
ArchitecUDesig
ner's Address —_
Telephone
F 777
—Zip
State
_ —_ — Lic. No.
City �
-- First
Last -- ail Address
[� 5. Engineer's Name LaEngineer's E -m
Engineer's Address
Telephone
Zip
State L—J Class U t6 36
City Lic. No.
First 'Sc,)_,,b ��r`^
F` - -
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6. Contractor's Name Last arc'- S`^k 2 Contractor's E-mail Address
Contractor's Address }vor ti"
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aids Telephone �1
r — ( Zip #1
State (, j'{
City S a 14 A ^ = PERMIT NO
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OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
PLAN CHECK NO. I
PLAN CHECK FEE $