HomeMy WebLinkAboutF2022-0470 - Permit Applicationvvomsneet Tor hire vermlt Application
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # ire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
Tenant Name
2. Description of Work
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Extg Sq Ft F7771 New/Added Sq Ft F77-7] Total Sq Ft y p a O
0'1!New ❑ Add ❑ Alter ❑ Demo
%.necK r►ppropriate rsox for Applicant/Notification
Floor Suite No
# Units
Use
Valuation $ & 0a7
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#Stories 2
❑ 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.
Architect/Designer's Address Architect/Designer's E-mail Address
City State ZIPt�Teleohone[7� -
❑ 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 K 1.t First Lic. No. Class 16
Contractor's Address Contractor's E-mail Address
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City Monl-k2utit/{� State Zip pi I Tele hone 1
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OFFICE USE ONLY PERMIT NO. 6'-t
TYPE OF CONSTRUCTION PLAN CHECK NO. �Gz ZZ
OCCUPANCY -GROUP Q_ dzz _(re SPLAN CHECK FEE $
161