HomeMy WebLinkAboutF2022-0014 - Permit ApplicationWorksheet for Fite Permit Application UPrintForm -Building Division City of Newport Beach Please print' copies
Associated Building Permit # �— F_ Fire Sprinkler j- Fire Alarm j— Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
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Tenant Name S �p a (� t R�St de ��
# Units F
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2. Description of Work
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Extg Sq Ft New/Added Sq Ft
Total Sq Ft H �}, n
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Valuation $ �p/ rj00.00
TOTAL. W
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Check Appropriate Box for Applicant/Notification
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(- 3. Owner's Name Last � First
Owner's Address
Owner's E-mail Address
City
State F_ Zip F Telephoned
F_ 4. Architect/Designees Name Last First Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F Zip I Telephone
r- 5. Engineer's Name Last First Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City �
State Zip F Telephoner-
6. Contractor's Name Last
Apt) fl First AL-1 Lic. No. yjO7 q Class G `6
Contractor's Address
Contractor's E-mail Address
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State !/1T Zip Vtl11 Telephon ?,10)�j��
OFFICE USE ONLY
vicl G 2 110 PERMIT NO.
TYPE OF CONSTRUCTION
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OCCUPANCY -GROUP
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PLAN CHECK FEE $ ter,
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��PoRT CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
PLAN SUBMITTAL FORM
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Print Name: ALI ADb'J
Signature:
❑ Pick-up Plans
Date:
Permit Tech:
Phone #:(31*0� 5b9- yjzz
Email: AAAi=tREcD(RGMAIL•COA4
Plan Check/Revision #: I Project Address Additional Information
mSubmitting Plans
Plan Check or Revision Number
Number of Plan
Sets or
documents
Name each document i.e., permit
application, plans, structural calcs, soil
report, etc.
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Payment Method
Payment can be made by credit card via phone at (949) 718-1888.
PAYMENTS MUST BE MADE AFTER 48 HOURS OF SUBMITTAL DUE TO QUARANTINE OF PLANS
Notes: