HomeMy WebLinkAboutF2021-0169 - Permit ApplicationWorkstreet°for'Fife Forni t.Application
Print Form n/ity of Newport Beach - Building Division
Please print 3 copies 2 0Z l vII 6
Associated Building Permit # I—
Fire Sprinkler r Fire Alarm r Fire Misc
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1. Project Address (Not mailing address)
Floor Suite No
Tenant Name
Owner's Address
# Units
2. Description of Work
City
State F
Zip F Telephone—
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Use
ArchitectlDesigner's Address
Valuation $I
Extg Sq Ft ',
New/Added Sq Ft Total Sq Ft
Zip I TelephoneF
F 5. Engineer's Name Last
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#Stories'
F_ New r, Add r
Alter n Demo
Engineer's E-mail Address
Check Appropriate Box for Applicant/Notification
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F_ 3. Owner's Name Last
First F—
Owner's Address
Owner's E-mail Address
City
State F
Zip F Telephone—
r 4. Architect/Designees Name Last
Fir s Lic. No.
ArchitectlDesigner's Address
Architect/Designer's E-mail Address
City
State
Zip I TelephoneF
F 5. Engineer's Name Last
i
First Lic. No. F
Engineer's Address
Engineer's E-mail Address
City
State F_
Zip F_ Telephone—
Lic. No. Z I Z-3 Class Fe - I
r 6. Contractor's Name LastJG �c First I (]J
Contractor's Address
Contractor's E-mail Address
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City e ib 1 S
State C'PI
zip G�`21 5i U Telephone 50 L�f S /U ri
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK N
OCCUPANCY - GROUP
V v ire VV
PLAN CHECK FEE $