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Associated Building Permit #
woricsneet Ivor Tire rerinit Application UNr
IN of Newport Beach - Building Division=20�` �� ��
ji`, EI l jT Fire Sprinkler Fire Alarm 1— Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Last
First V
—
#Units
Tenant Name-'
Owner's E-mail Address
2. Description of Work
Use
State
Telephone[-7""
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Valuation $ r -'
Extg Sq Ft �� New/Added Sq Ft Total Sq Ft r
F_ 4. Architect/Designer's
Name Last
# Stories
F_New F—Add F` Alter F_ Demo
Check Appropriate Box for Applicant/Notification
IMFRYlY47A1AM
l 3. Owner's Name
Last
First V
Owner's Address
Owner's E-mail Address
City
State
Telephone[-7""
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F_ 4. Architect/Designer's
Name Last
First F Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City �
State F_Zip
F_ Telephoner--.-----
5. Engineer's Name
Last ):,. _ a j 4 (c.'i ' First r_Lic No. E, �'`j , I
Engineer's Address
Engineer's E-mail Address
City
State
Zip Telephoner-----
6. Contractor's Name
Last ! FirstLic No.'Class F
Contractor's Address
Contractor's E-mail Address
City �_
it
State ( yi
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Zip �, %L Telephone ' l
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OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. fl121C Z'0 -It
OCCUPANCY- GROUP
PLAN CHECK FEE $