HomeMy WebLinkAboutF2019-0234 - Permit ApplicationU4,11",
or s ee or Fire ermlt Application PrintForm- , City of Newport Beach - Building Division
Please print 3 copies �Q I — o Z�
Associated Building Permit # I_ Fire Sprinkler F_, Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
A00S1
First
Tenant Name# Units F-- —
2. Description of Work
Owner's E-mail Address
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Use
F;S4Extg Sq Ft New/Added Sq Ft Q
�7/ Total Sq Ft 6 Lrr'
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Valuation$
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# Stories
I—, New JW Add 1 Alter F_Demo
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name
Last
First
Owner's Address
Owner's E-mail Address
City I
State
Zip Telephoned
4. Arch itect/Designer's
Name Last
First F Lic. No.l
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State
Zip Telephone
F` 5. Engineer's Name
Last
First r Lic. No. ---
Engineer's Address
Engineer's E-mail Address
City
State r
Zip Telephoned
6. Contractor's Name
Last PrI�(� First �O�� Lic. No. Class FEio
Contractor's Address
Contractor's E-mail Address
City OEFP ,iw
State r
Zip I C(IST) Telephone IUl S7 ij I1(�U
t
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. UU�r I GI
OCCUPANCY- GROUP
PLAN CHECK FEE $ 1'��