HomeMy WebLinkAboutF2022-0498 - Permit ApplicationvvorKsneet Tor Tire vermit Application of
Print Forme z ��
City of Newport Beach -Building Division
Please print 3 copies C9< F00.NP
Associated Building Permit#
❑Fire Sprinkler ❑Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
F-71
---- —
# Units F ___
Tenant Name eu)P",A-
2. Description of Work
Use � 1 �. r
%�'Mv►`U VNk C'C�
Z �1
Valuation $ j0 1 E;c•U,
i
Extg Sq Ft � New/Added Sq Ft Total Sq Ft
# Stories
New ❑ Add ❑ Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last J First
Owner's Address Owner's E-mail Address
I
City State1_77 Zip I Telephone
❑ 4. Architect/Designer's Name Last Firstk Lic. No.�� 5'3
Architect/Designer's Address Architect/Designer's E-mail Address
City tit ,y.` State I _ J Zip ����j Telephone q- �pr, . t l T� 31 "4-
5. Engineer's Name Last First Lic. No. F-A
Engineer's Address Engineer's E-mail Address
' i I
_--__ State --JI TelephoneCity �
z i P
_ 6. Contractor's Name Last � � _ First ,7, __ Lic. No. (o ff Class (%tU
Contractor's Address Aj /�/✓k-&j0, c-�4ontractor's E-mail Address
City �v tAlyk- _ State C', Zip q2� �(� J Telephone t� S's� 3 5/1
OFFICE USE ONLY PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP PLAN CHECK FEE $