HomeMy WebLinkAboutX2021-0635 - Permit ApplicationPrint Form -`
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City of Newport Beach - Building Division
Please print 3 copies `� ,FSMRr
Associated Building Permit #
1. Project Address (Not mailing address)
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Tenant Name k'ztc_ UwDt
2. Description of Work
0162,U; � ❑ Fire Sprinkler ❑Fire Alarm ❑ Fire Misc
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Extg Sq Ft New/Added Sq Ft Total Sq Ft
❑ New ❑ Add 10 Alter ❑ Demo
Check Appropriate Box for ApplicanVNotification
Floor Suite No
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# Units
Use
Valuation $ FK514
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❑ 3.Owner's Name Last First
Owner's Address Owner's E-mail Address
City State L� Zip Telephoned
❑ 4. Arch itect/Designer's Name Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State I Zip Telephoned
❑ 5. Engineer's Name Last First Lic. No.
Engineer's Address Engineer's E-mail Address
city State Zip , Telephoned
❑6. Contractor's Name Last— First —75� Lic No. 'L( Class e ,
Contractor's Address Contractor's E-mail Address
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City State e Zip! Telephone F(
OFFICE USE ONLY PERMIT NO. ,GjDZZ
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP PLAN CHECK FEE $