HomeMy WebLinkAboutF2022-0445 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
VVOrKSneet Tor rice rermlt Application
City of Newport Beach - Building Division
Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
Suite
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❑Floor —No
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Tenant Name
# Units
2. Description of Work
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Use
Valuation $ 15 O O
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Extg Sq Ft New/Added Sq Ft
Total Sq Ft i
#Stories
New ❑ Add ❑ Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last 7
First CAA;; (
Owner's Address
Owner's E-mail Address
City State Zip
j Telephone
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❑ 4. Architect/Designer's Name Last
First Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City State Zip
�I: Telephone;
❑ 5. Engineer's Name Last
First Lic. No.
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Engineer's Address
Engineer's E-mail Address
City State l Zip
F! Telephone[77_77
D.%6. Contractor's Name Last Fit LicNo'I$Class L-b�n��yS
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Contractor's AddressContractor's
E-mail Address
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OFFICE USE ONLY
PERMIT NO. OyUS
TYPE OF CONSTRUCTION
PLAN CHECK NO t -�
OCCUPANCY - GROUP
PLAN CHECK FEE $