HomeMy WebLinkAboutX2019-0393 - Permit Application (3)- Print Form i _
Please print 3 copies
Associated Building Permit #
i. rrolectwaaress (Not mailing
a('.-26 8QSSL 004
Tenant Name
2. Description of Work
Worlfsheetfor=Fife Permit°Application
City of Newport Beach - Building Division
WK Fire Sprinkler FFire Alarm j- FireMisc
h A(/ e n s
Extg Sq Ft Fo 000 New/Added Sq Ft p O
F New jjj- Add j- Alter j- Demo
Check Appropriate Box for Applicant/Notification
F 3. Owner's Name Last
Owner's Address
City
MN
Total Sq Ft
Owner's E-mail Address
State F Zip Telephone
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Floor Suite No
# Units �—
Use I Res,JQW4,4n,e,
Valuation $ / 5 B J
# Stories I
F 4. Architect/Designer's Name Last
First F� Lic. No. F-
Architect Designer's Address Architect/Designer's E-mail Address
City State r—
ZIP F� TelephoneF�
F 5. Engineer's Name Last First
Lic. No.I--
Engineer's Address
Engineer's E-mail Address
City I State F_
ZAP F_ TelephoneF�
F 6. Contractor's Name Last CQ c �, r d First r n
°� Lic. No. j 8604 Z Class f
Contractor's Address
Contractor's E-mail Address
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City I O r ra n C e State C A Zip 9 09D( Teleepphone 9 tt7 9 53 S yy '%
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP O v�
PERMIT NO. —6=
PLAN CHECK NO.
t PLAN CHECK FEE $
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