HomeMy WebLinkAboutF2022-0434 - Permit Applicationvvorrcsneet Tor rire vermit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies F2U Z2— GL(-3
Associated Building Permit# V Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
Tenant Name Lvyam. k
2. Description of Work
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Extg Sq Ft F-7-71 New/Added Sq Ft Total Sq Ft
❑ New ❑ Add ❑ Alter ❑ Demo
Floor
# Units
Suite No
Use 1. _7
Valuation $
# Stories TI
Check Appropriate Box for Applicant/Notification t" V O
❑ 3. Owner's Name Last k r "e-, C, a� First
Owner's Address
Owner's E-mail Address
City
State ® Zip [� Telephone[
❑ 4. Architect/Designer's Name Last
y IG
C ,.Pyz � First ��'� ( Lic. No, s8 `t Z&S
Architect/Designer's Address
Architect/Designer's E-mail Address
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City /LiiAM/
State Zip 9Z G S '� Telephone 4(4) -3 Ili -alu
❑ 5. Engineer's Name Last First Lic. No.
Engineer's Address
Engineer's E-mail Address
City 1
State F-771 Zip TelephoneL
❑ 6. Contractor's Name Last Cyr Ja.. First 'p�, ; , Lic. No. Class
Contractor's Address
Contractor's E-mail Address
City MY dJ�,4Iu
State Zip 9 Z6S5' ! Telephone
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. QU��
OCCUPANCY - GROUP
PLAN CHECK FEE $
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