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HomeMy WebLinkAboutX2019-1169 - Permit Applicationat Pflnt Form please print 3 copies Associated Building Permit # t, project Address rm �nAp � phton�Perim Worksheet for a Division�B�Z City of Newport Beach -Building go jq f20 9Q O 2Q Sprinkler Fire Alarm ❑ Fire Misc Fire Sp Sul address) Floor 2S 0� 2R ., �� • s # Units Tenant Name -- Use 2. Description of Work n vI �, \ !/ ,rJ k, ke iju� .'e it', S�'l nc, S., 1't`1M,8r�____-- — Valuation$11(ioo --- — 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` - - V rS 6. Contractor's Name Last arc'- S`^k 2 Contractor's E-mail Address Contractor's Address }vor ti" {:rt, Sw1N- �rSk.L M �„ Sk. _ Hip aids Telephone �1 r — ( Zip #1 State (, j'{ City S a 14 A ^ = PERMIT NO n nn n1 OFFICE USE ONLY TYPE OF CONSTRUCTION OCCUPANCY - GROUP PLAN CHECK NO. I PLAN CHECK FEE $