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City of Newport Beach - Building Division F'.2(919 _ o Ss G
Please print 3 copies
Associated Building Permit # I I— Fire Sprinkler [I Fire Alarm r! Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name s. -+C f �S # Units,..
2. Description of Work
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Extg Sq Ft C(3 r] New/Added Sq Ft —i Total Sq Ft —
Valuation $
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New r— Add r Alter r Demo
# Stories
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
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Owner's Address
Owner's E-mail Address
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State Zip �— Telephone[
F_ 4. ArchitecDesigner's Name ast
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Lic. No.
Architect/Design
ArchitecUDesigner's E-mail Address
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F 5. Engineer's Name Last
First F_
Lic. No.l
Engineer's Address
Engineer's E-mail Address
City �—
StateI Zip Telephone��
[7 6. Contractor's Name Last ( �SW��F F_� ��— Lic No. �c/�i 7� Class
Contractor's Address
Contractor's E-mail AddressA � K
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State Zip
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OFFICE USE ONLY
�Lose• 4 PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
7 /y ` '�y� PLAN CHECK FEE $��
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