HomeMy WebLinkAboutF2021-0103 - Permit Application'Fite
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ocka reetyfor Fite Permit Application o4
Print Form e
- ---- City of Newport Beach - Building Division
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Please print 3 copies
Associated Building Permit # Fire Sprinkler r Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor /Suite No
Tenant Name ' V 6�Gx # Units
2. Description of Work
Use
Valuation $ 3TcjJ-
Extg Sq Ft F_New/Added Sq Ft � �-®- --- Total Sq Ft
New F- Add r Alter F_ Demo # Stories F
Check Appropriate Box for Applicant/Notif!cation
F_ 3. Owner's Name Last
First 7-
Owners Address
Owner's E-mail Address
City
State F_ Zip F_ Telephoned
4. Architect/Designer's Name
Last First Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State F_ Zip I Telephone
F- 5. Engineer's Name Last
r/ f f� First .Ave Lic No.
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Engineer's Address
Engineer's E-mail Address
City r'1(_—,� f
State ZpJ �'�j�l Telephone I -7 /L/. q 3,3 ^ 6c) 6� I
r- 6. Contractor's Name Last
First I 5'?j15V Lic. No. i7,�Y,)-3 class /(,
Contractor's Address
Contractor's E-mail Address
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City vw 6C k
State Zip F C 2 Telephone -,711-1 - c0 i 7- G
OFFICE USE ONLY
�G(1Gi��1 PERMIT NO. C44,1-
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP�Vt
PLAN CHECK NO. um, M7
/ 69 PLAN CHECK FEE $