HomeMy WebLinkAboutF2021-0072 - Permit ApplicationPrint Form M1
Please print 3 copies
Associated Building Permit #
Worlishadt for`Fife Perrnit Application
City of Newport Beach - Building Division
Fire Sprinkler r Fire Alarm I— Fire Misc
1. Project Address (Not mailing address)
Clt
Tenant Name � ` I
2. Description of Work
Extg Scl Ft -� New/Added Sci Ft
F_ New r Add F_ Alter F_ Demo
C:neck Appropriate Box for Applicant/Notification
Total Sq Ft F
Floor Suite No
# Units
Use
Valuation $ F—
# Stories F
F_ 3. Owner's Name
Last
First �—
Owner's Address
Owner's E-mail Address
City
State F
Zip F—Telephonelen A �(v
r 4. Architect/Designer's Name Last
First F Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State F—
Zip Telephone
F 5. Engineer's Name
Last
First F_ Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City
State �—
Zip F_ Telephoned
6. Contractor's Name Last
> a _ First Lic. No. �s3I Class C i
��i
Contractor's Address
Contractor's E-mail Address
P- i' P 1 /Q
F i,r`c �) 'k 1 Cd,M
City 7 1 i—� LL ._ I I
n V,e State
1 `
Zip Telephone 'j (Y.— Z 3 y ��
OFFICE USE ONLY
PERMIT NO. }� ZO
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $