HomeMy WebLinkAboutF2021-0615 - Permit Application1 City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # j �/Fire Sprinkler E' Fire Alarm
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1. Project Address (Not mailing address) l� �F—loor— Suite No
Tenant Name # Units
2. Description of Work
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Extg Sq Ft New/Added Sq Ft 7 Total Sq Ft 1
Valuation $
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Fj New ❑ Add ❑ Alter ❑ Demo
# Stories n
Check Appropriate Box for Applicant/Notification
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3. Owner's Name Last j_rl j r �Or 0 First
Owner's Address-�`�'--�-Jt Owner's E-mail Address
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City State Zip [CF__ Telephone
4. Architect/Designer's Name Last �— First, Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City L _ State — Zip —, Telephone
5. Engineer's Name Last er �p fi rstF LicNo.
Engineer's Address Engineer's E-mail Address
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City _ State C Zip Telephone
[6. Contractor's Name Last l vi First Lic. No. %Class C
Contractor's Address Contractor's E-mail Address
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City I ��[� State C Zip Telephone "G __
OFFICE USE ONLY PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO. S"o e 202.1
OCCUPANCY - GROUP ��LI 6�, PLAN CHECK FEE $