HomeMy WebLinkAboutF2021-0332 - Permit ApplicationPrint Form A
Please print 3 copies
Associated Building Permit #
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City of Newport Beach - Building Division
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1. Project Address (Not mailing address) Floor Suite No
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Tenant Name (�' o 1. . �+.._. _ #Units
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2. Description of Work
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Check Appropriate Box for Applicant/Notification
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3. Owner's Name Last1
First �- -
Owner's Address
Owner's E-mail Address
City
State �--
Zip r----- Telephoner
F7 4. Arch itect/Designer's Name Last 1 FirstLic. No. — ---
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Architect/Designer's Address
Architect/Designer's E-mail Address
City
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Zip I---- Telephone(.—
F 5. Engineer's Name Last
First— Lic. No. F—''
Engineer's Address
Engineer's E-mail Address
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State �--
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r 6. Contractor's Name LastFContractor's
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ic. No. Class -
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Contractor's Address
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E-mail Address 3
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OFFICEVV USE ONLY
PERMIT NO. wT L — U33 Z -
TYPE OF CONSTRUCTION —
PLAN CHECK NO. - Z-0 Z(
OCCUPANCY - GROUP
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_ GI� PLAN CHECK FEE $