HomeMy WebLinkAboutF2021-0192 - Permit Application (2)Print Form
Please print 3 copies
Associated Building Permit #
Wbrk§fte`tfor FjrYe ftrmitApplication
City of Newport Beach - Building Division
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Fire Sprinkler F Pire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Last �— First �—
Tenant NameMA-iv o 5 #Units—',
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2. Description of Work
Owner's E-mail Address
Use
State F_ Zip Telephone
[—
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Extg Sq Ft New/Added Sq Ft
Valuation $ �0
g00
Total Sq Ft i
New r Add ri Alter (— Demo
# Stories f
Check Appropriate Box for Applicant/Notification
F 3. Owner's Name
Last �— First �—
Owner's Address
Owner's E-mail Address
City �—
State F_ Zip Telephone
[—
F 4. Architect/Designer's Name Last First [_ Lic. No.
I
Architect/Designer's Address
Architect/Designer's E-mail Address
City �—
State �— Zip Telephone'
5. Engineer's Name
Last First Lic. No.
F—,
Engineer's Address
Engineer's E-mail Address
City
State Zip 7 Telephone
r 6. Contractor's Name Last
First y1,- Lic. No. 9� oln- Class 7/�;
Contractor's Address
Contractor's E-mail Address
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City fjZ/!5o ��o
State �— Zip 9,9&T& Telephone 9¢9) 22e, -/19,L
OFFICE USE ONLY
PERMIT NO. '
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
X PLAN CHECK NO.
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PLAN CHECK FEE $