HomeMy WebLinkAboutF2021-0449 - Permit Application (2)vvorKsnee Tor i'ire vermit Appilicavoin
Pfmt Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # ❑ Fire Sprinkler Kj Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
Tenant Name
2. Description of Work
t�ti, 4\�iIt— /V�,,A•-1",i
Extg Sq Ft New/Added Sq Ft Total Sq Ft
Q New ❑ Add ❑ Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last First
Use
UIR
Floor Suite No
#Units
Valuation $ J
# Stories
Owner's Address Owner's E-mail Address
City State Zip Telephoned
❑ 4. Architect/Designer's Name Last First 1777-71 Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip � Telephone��
❑ 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 Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State Zip Telephone
`FICE USE ONLY PERMIT NO. �wy
?E OF CONSTRUCTION PLAN CHECK NO. 4c,1 v22.21
'UPANCY -GROUP 1� PLAN CHECK FEE $