HomeMy WebLinkAboutF2022-0493 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
worKsneet Tor Tire vermlt Application of - e
City of Newport Beach - Building Division
�f Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
c7
(0&✓w5
Tenant Name
# Units I
I -
2. Description of Work
Ivshl
7>y5Vew-
Use
Valuation $
Extg Sq Ft
New/Added Sq Ft � Total Sq Ft 3�S
36C
K New ❑ Add
❑ Alter Demo
# Stories
❑
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name
Last _ First��
Owner's Address
Owner's E-mail Address
City
State Zip Telephoned
❑ 4. Architect/Designer's Name Last First Lic. No. I
Architect/Designees Address
Architect/Designer's E-mail Address
City
State Zip F777 Telephoned
❑ 5. Engineer's Name
Last . First Lic. No.
IIII���JJJJ
Engineer's Address
Engineer's E-mail Address
City
State Zip Telephoned
F6. Contractor's Name Last ou4,J First Lic. No. 5W71 Class C16
Contractor's Address
Contractor's E-mail Address
City Lug �I.}` State Zip C(2G3o; Telephone GjH _SIs7- 53�
OFFICE USE ONLY
PERMIT NO. F2-022- 0Ljg3
TYPE OF CONSTRUCTION
— PLAN CHECK NO. PC 2G`L2'Z_D G O
OCCUPANCY - GROUP
PLAN CHECK FEE $