HomeMy WebLinkAboutF2021-0151 - Permit ApplicationWorkshe6tlar� �TePern1lit-Application o�"He
Print Form City of Newport Beach - Building Division
Please print 3 copies W Z 'Lv � ` Vvv ,��
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Associated Building Permit # re Sprinkler r Fire Alarm [, Fire Misc
1. Project Address (Not mailing address)
Tenant Name _ ( \/6' �
2. Description of Work
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Extg Sq Ft New/Added Sq Ft F Total Sq Ft
F_ New F_ Add f— Alter rl Demo
Check Appropriate Box for Applicant/Notification
Floor
# Units
Suite No
Use _., v V
Valuation $ F,e2/
# Stories Iry
(— 3. Owner's Name Last l
First F_'
Owner's Address
Owner's E-mail Address
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City�� �� r �JC�.
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State)
Zip Telephone
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F_ 4. Architect/Designees Name Last
First '' Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State
Zip TelephoneF—
c, 5. Engineer's Name Last F
First F Lic. No. F
Engineer's Address
Engineer's E-mail Address
City
State F_
Zip F_ Telephone
F_ 6. Contractor's Name Last
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Lic. No. !t/ '7 Class E' 1�,
First F6rs
Contractor's Address 63
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� Address
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City / C 14.;7
State �—
Zip 9 Telephone �6v .-"7 �j JS
OFFICE USE ONLY
� L( PERMIT NO.
TYPE OF CONSTRUCTION An
Z40 L-E! s
V �C5 PLAN CHECK NO.
V
OCCUPANCY- GROUP
PLAN CHECK FEE $
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