HomeMy WebLinkAboutF2022-0016 - Permit ApplicationWorktheet for,Rire Permit- pplication
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit J:�,: Fire Sprinkler I- Fire Alarm (- Fire Misc
1. Project Address (Not mailing address)
1170 Km)� Koad
Tenant Name
2. Description of Work
FI u ��rl`rl k��ts �oY Sr R (5 y 5pr pi Hers
Extg Sq Ft F— New/Added Sq Ft F— Total Sq Ft F_
F_ New F_ Add F- Alter j- Demo
cnecK Appropriate Box for Applicant/Notification
UN,
Floor Suite No
# Units F
Use �� ) • JX
Valluation$ R poo,
# Stories n 2
F- 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City
State F Zip �� Telephoned
F_ 4. Architect/Designer's Name
Last U6, First p yt Lic. No.
Architect/Designer's Address
Arc itect/Designer's E-mail Address
52G
�ire 01 vavj S,5W?91flai Isom
City utloS I _.d �1 ri
Stater Zip 1 Telephone(vq wo-om
F_ 5. Engineer's Name Last
First F — Lic. No.
Engineer's Address
Engineer's E-mail Address
City I
State Fi Zip F— Telephoned
6. Contractor's Name LastFF_f(�' `�l Snfr� �l, First Lic. No. RNZGG Class
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Contractor's Address
Contractor's E-mail Address
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) re UAr coiv)
City TovvQ
State �— Zip �(J GT (_ Telephone (71y) �/Q_Q( f l
OFFICE USE ONLY
PERMIT NO.
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TYPE OF CONSTRUCTION
/ PLAN CHECEC K NO.
OCCUPANCY - GROUP
��/ r LAN CHECK FEE $
J�-
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
PLAN SUBMITTAL FORM
cq</Fp RN P.:
Print Name: h d
Signature:
❑ Pick-up Plans
Date:
Permit Tech:
Phone#- j1l JIQ'61Y
Email:1 ire nveords5rdo7martom
Plan Check/Revision #: Project Address Additional Information
N Submitting 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.
G
`Q
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: