HomeMy WebLinkAboutF2021-0337 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
• v• •`City of Newport Beach -Building Division M"v„
K Fire Sprinkler r Fire Alarm F! Fire Misc
1. Pro�jject Address (Not maai�ling address) Floor Suite No
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Tenant Name }kos(� Q # Units
2. Description of Work
Owner's Address
[�a C. (OFF eMRE E 'V-nV j �
Use
City _.. _.
,
Valuation$ 1D----',
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Extg Sq Ft 3y, (awl New/Added Sq Ft 11 �" Total Sq Ft °i`� , (R(P�
r 4. Architect/Designer's
Name Last � � ', Fir sll Lic.
# Stories F
r New r Add � Alter [_Demo
Check Appropriate Box for Applicant/Notification
F– 3. Owner's Name
Last
First r— ---
Owner's Address
Owner's E-mail Address
City _.. _.
_ State r-_
Zip F— Telephone[�
r 4. Architect/Designer's
Name Last � � ', Fir sll Lic.
No.
Architect/Designer's Address
Architect/Designer's -mail Address
City .._
State F_.
Zip Telephoner
F_ 5. Engineer's Name
Last
First F --- Lic
No.I
Engineer's Address
Engineer's E-mail Address
City
,. State F_
Zip Telephoner
6. Contractor's Name
Last VevtZ First Lic. No. 9;'n3
Class CZ
Contractor's Address
Contractor's E -/mail Address
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City
State FC'
ZipyipiG, Telephone oz �5`f c�OS {
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. ���'
n2
• W21
OCCUPANCY- GROUP
l , �j��l PLAN CHECK FEE $