HomeMy WebLinkAboutF2021-0635 - Permit ApplicationPlease print 3 copies
Associated Building Permit #
t. Project Address
Tenant Name
2. Description of Work
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City of Newport Beach - Building Division
� ❑Fire Sprinkler � Fire Alarm 'Fire Misc
M21 U�6
ailing address)
Floor
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Extg Sq Ft I�--� r----�
-__--.-�i New/Added Sq Ft � I Total Sq Ft I
A New ❑ Add—
❑ Alter ❑Demo
Check Appropriate Box for ApplicantlNotification
❑
3. Owner's Name Last �—
Owner'sAddress —� Firste—�?
# Units
Suite No
177
Valuation $ Z�K
# Stories M
Owner's E-mail Address
City-- I -----�
State Zip j
4. Architect/Designer's Name Last
Architect/Designer's Address --� First Lic, No.
I
City
—__-_,-----_ State �—
r 5. Engineer's Name
Architect/Designer's E-mail Address —
Zip F___� Telephone!
Last
First
Engineer's Address
City �------------ -----.
State
Lic. No. L
Engineer's E-mail Address
Zips Telephonee
Xe. Contractor's Name Last -
a�,�r i - - -- - Lic. No.
First
Contractor's Address rIG� �t �� ---- r—, Class -� f6J
-- -
city-
�1�6-._._------- State �-
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
Contractor's E-mail Address
Zip Telephone
PERMIT NO. F� zl - /h( �S
PLAN CHECK NO. ZRQY-ZUZI
PLAN CHECK FEE $
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