HomeMy WebLinkAboutX2007-3235 - Permit ApplicationWORKSHEET FOR BUILDING ! FIRE PERMIT APPLICATION
�" CITY OF NEW PORT BEACH
s BUILDING DEPARTMENT �Zou l-3.2 Z)o
PLEASE PRINT OR TYPE
1-. PROJECT ADDRESS (NOT MAILING ADDRESS) FLOOR SUITE NO.
LVI
IF,
2.DESCRIi
I
BLOCK
OF WORK
TRACT
NEW ❑ ADD ALTER ❑
Check Appropriate Box for ADDlicant
No. UNITS
:lL5 USE gnF
# OF STORIES
VALUATION $ aozo—coz,
DEMO ❑ SQ FT 1p
(NEW/ADDED/EXTG)
❑ 3. OWNER'S NAME LAST FIRST
116IJ
OWNER' ADD ESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
-qt]�--Z/3
❑ 4. ARCH ITCT/DESIG ER'S NAME LAST FIRST
C-H
LIC. NO.
f ord
ARCHITECT/DESIGNER'S ADDRESS
ARCHITECT/DESIGNER'S
E-MAIL ADDRESS
D b
CITY STATE 7IFf
PHONE 0.
0
❑ 5. ENGINEER'S NAME LAST FiRsr
STATE LIC. NO.
ENGINEER'S ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP✓
PHONE NO.
❑ 6. CONTRACTOR'S NAME
BUSINESS LIC.
STATE LIC.
lass
CONTRACTOR'S ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE ZIP
5 a3
PHONE NO.
c�a
0FFfC!7 USF ONLY i
I� a� PERMITnnN
TYPE OF CONSTRUCTION ( J J 10. i �f+E NO.—y
_
—I LANCHECK�jG
OCCUPANCY - GROUP CIC'
t
ones 9_aPP i� ion
t N 3's 1-2