HomeMy WebLinkAboutF2021-0380 - Permit ApplicationWorksheet -for Piro Permit Application
City of Newport Beach - Building Division r
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Please print 3 copies
Associated Building Permit # _ ❑ Fire Sprinkler Fire Alarm Fire Misc
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1. Project Address (Not mailing address)
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Tenant Name
Floor Suite No
# Units =
2. Description of Work Use ❑ �9 `'�'�
IJ
'^ Valuation $E�w
Extg
Sq Ft New/Added Sq Ft _ J Total Sq Ft # Stories ❑j �I
❑ New ❑ Add ❑ Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last ,[First
Owners Address Owner's E-mail Address
State ❑❑�� ,, Zip Z C Telephone n
city 2� iJ✓� L vP< I------C... ii V--=-
First Lic, No.
❑4. Architect/Designer's Name Last —__----___—_)
Architect/Designer's Address Architect/Designor's E-mail Address — —�
— --- —� State ❑ ❑ J Zip ❑—❑ Telephone —
City -------- ❑�❑
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❑ 5. Engineer's Name Last -`-__ First Lic. No.—_—. -
Engineer's Address Engineer's E-mail Address
City G'�j�Qli j State C j Zip Telephone J
Lic. No. Class
6. Contractor's Name Last ��lt ❑— ❑
❑—1
-- -- ----
Contractor's Address Contractor's E-mail Address
City — --, State ❑—❑ Zip ❑—�I Telephone -
PERMIT NO.
OFFICE USE ONLY
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP PLAN CHECK FEE $