HomeMy WebLinkAboutF2021-0171 - Permit Application (2)(Print Form'
Please print 3 copies
Associated Building Permit #
WorkshemafofnPim'ir..ParmnitrApplicatioh U64,11-13City of Newport Beach - Building DivisionZO
%' Fire Sprinkler r Fire Alarm ) Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name A/4,4eW C'c c �q 7 t�r'J # Units
/ I
2. Description of Work
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Use
Extg Sq Ft New/Added Sq Ft Total Sq Ft
Valuation $jao
F_ New F7, Add `Alter r, Demodf v
#Stories
Check Appropriate Box for ApplicantlNotification J �'
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F 3. Owner's Name Last
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First [ I
Owner's Address
Owner's E-mail Address
City
State F
Zip Telephone
C 4. Architect/Designer's Name
Last
I FirstF Lic. No.I
Architect/Designer's Address
Architect/Designees E-mail Address
City �
State �'i
Zip Telephone
F, 5. Engineer's Name Last
�, First F Lic. No.
Engineer's Address
Engineer's E-mail Address
State [—ZIP
F—Telephone[—
,City
I/ A. Contractor's Name Last r',� p nt! ec 'o . �� ,r, q �l Lic. No. �(Lv9�5 Class
Contractor's Address
Contractor's E-mail Address
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LLS6",Py c�{�rra�ec4'
City 10./2 a'
State (°
Zip tI 00&, TelephoneF?) L(' CO �sS, Lo
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK N Y r
OCCUPANCY- GROUP
L14
PLAN CHECK FEE $
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