HomeMy WebLinkAboutF2021-0116 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet forFii'e Permit"Application
City of Newport Beach - Building Division
F_ Fire Sprinkler F✓Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
4 7s M�_-c Arl1,<
Tenant Name I (NIA
2. Description of Work
Extg Sq Ft I Lj, 012-A New/Added Sq Ft F Total Sq Ft
F_ New j— Add Alter F_ Demo
Check Appropriate Box for AppIicant/Notification
Floor Suite No
t'i -7 t9
# Units f
Use I b g C.E 16
Valuation$ 5133,c)M
# Stories I (D
F 3. Owner's Name
Last NNAY- ('cvirxp_ ce)) First �p
Owner's Address
Owner's E-mail Address
I,1 `V\VIU,�? {�V ir.
City Ir e
State f � Zip C 2-Q 17 Telephone i �-j ri _ � ZO _2-4 00
F-4.Architect/Designer'sName
Last kCI1y (LektvC) First J yh�_� Lic. No. ('1233
Architect/Designer's Address
Architect/Designer's E-mail Address
City 1;
��
State— Zip !� 2
r 5. Engineer's Name
Last Ui� I aZav f C First �l 1 Lic. No. 729�jo�
Engineer's Address
Engineer's E-mail Address
'2-?Lilo L (,,e r 2-L)
\A
City if-`
State C."-A Zip gl7-to Te1ephonecj0 F3os--lloCIo
F 6. Contractor's Name
Last First Lic. No. F—Class �—
Contractor's Address
Contractor's E-mail Address
City �
State F__ Zip F_ Telephonef i
OFFICE USE ONLY
PERMIT NO. oil
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $