HomeMy WebLinkAboutF2021-0132 - Permit ApplicationPrint Form i
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3 copies
Please print 3 coCity of Newport Beach - Building Division F v0?,1 -(7(32
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Associated Building Permit# polo —j?411 354,7e&, j�, Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
19 ? 3 Po 2T L,,,4Ac> �� F F—
Tenant Name�Css�(� I�W��LrN� (�/JiT j I L! #Units
2. Description of Work
Owner's E-mail Address
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Extg Sq Ft New/Added Sq Ft Total S Ft
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Valuation $ %w
State
# Stories I /
rl New r Add F-Alterr Demo
Last
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name Last
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First
Owner's Address�j
Owner's E-mail Address
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City U k h.WA
State
Zip. 12705_ Telephone 7` y
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F 4. Architect/Designer's Name
Last
FirstF— Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �—
Zip Telephoner'I
5. Engineer's Name Last
First �— Lic. No. F
Engineer's Address
Engineer's E-mail Address
City
State F
Zip F Telephoned
r6. Contractor's Name Last �u I'I/–fir i�d�bY�,-/UtUI
IWFFirst Jam Gc�sv� Lic. No. (�l7Z,z Class c12,
Contractor's Address
Contractor's E-mail Address
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City
State FTT—
Zi G.o / Telephone
OFFICE USE ONLY
��� PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. Q7
OCCUPANCY- GROUP
PLAN CHECK FEE $