HomeMy WebLinkAboutF2021-0161 - Permit ApplicationPrinWorkshestfor-FireTbromlt Application " ' K@ :
t Form �
- - City of Newport Beach - Building Division 'n9 52—��
Please print 3 copies
Associated Building Permit # �a F Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
— — C�OfY1&+NIDIn i C�DY�ui, � �GtrF_
Tenant # Units
Tenant Name p , ��
2. Description
of
ofWork
L(
d�YGSUse
Extg Sq Ft New/Added Scl Ft Total Sq Ft Valuation $
F_ New � Add F_ Alter j` Demo # Stories
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name Last �—
First
Owner's Address
Owner's E-mail Address
City
State F_
Zip Telephone_
F_ 4. Architect/Designer's Name Last
�—
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �—
State
Zip F Telephone��
F_ 5. Engineer's Name Last F
�
� First Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State F_
Zip Telephone
F,6. Contractor's Name Last j S First I CDM+cyLic. No. �� ]� Class C.1
Contractor's Address
Contractor's E-mail Address
119 &V/2z
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City ��
�I Cp
State
/
Zip �t20� j� Telephone
OFFICE USE ONLY
! PERMIT NO.
TYPE OF CONSTRUCTION
�11 l
l�
•�/ PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $