HomeMy WebLinkAboutF2021-0201 - Permit Application"orksheet Ttr =Fife Permit Application ��
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%JT✓ City of Newport Beach - Building Division
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Please print 3 copies ��
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Associated Building Permit t(//f ✓ire Sprinkler, Fire Alarm r Fire Misc Z
1. Project Address (Not mailing address) Floor Suite No
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Tenant Namee5�s 7� _ , , # Units
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2. Description of Work at
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Extg Sq Ft New/Added Sq Ft Total Sq Ft
New [-; Add r Alter F7, Demo
Check Appropriate Box for Applicant/Notification
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Valuation $
# Stories
J 3. Owner's Name Last,
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Owner's Address
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Owner's E-mail Address
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City 1 ' j ' " ' -
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ZiP vr/ C' Telephone,; -j g( ii-gl?�
rj 4. Architect/Designer's Name Last First F_Lic. No. �
Architect/Designer's Address
Architect/Designer's E-mail Address
City �— State �—,
Zip Telephone
F7 5. Engineer's Name Last) 1 JS �y� First /(�
.� Lic. No.
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Engineer's Address
Engineer's E-mail Address
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C�� State ��
P �- Telephone�r2�
6. Contractor Name Last Q, `l
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First Lic. No.
Contractor's Addres
Contractor's E-mail Address
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City—i t� State
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Zip -C Telephone
OFFICE USE ONLY PERMIT NO. r
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TYPE OF CONSTRUCTION
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PLAN CHECK NO.
OCCUPANCY - GROUP e/
), PLAN CHECK FEE $