HomeMy WebLinkAboutF2021-0170 - Permit Application• 'V�olrksfre�t�fo�''F:i�e Perrriit`Applcatioir
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City of Newport Beach - Building Division 1 �1 o
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Associated Building Permit # 17 Fire I� F_1 Fire Alarm F Fire Misc
1. Project Address (Not mailing address)
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Suite No
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Tenant Name
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2. Description of Work
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Valuation $/
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Extg Sq Ft New/Added Sq Ft Total Sq",
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# Stories _1
F New I- Add F-! Alter F -J Demo
Check Appropriate Box for Applicant/Notification
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�, 3. Owner's Name Last First 7—I
Owner's Address Owner's E-mail Address
City State Zip - Telephone
F7 4. Architect/Designer's Name Last IUI t r� �� First Lic. No.
Architect/Designer's Address ArchitectlDesigner's E-mail Address
City StateF ' Zip —II Telephone
r; 5. Engineer's Name Last First Lic. No. I
Engineer's Address Engineer's E-mail Address
City State �, Zip Telephone�—
F, 6. Contractor's Name Last �u�N n/ First NoL f Lic. No. 558 6 Class
Contractor's Address Contractor's E-mail Address
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City I LAr - StateI t-I'r Zip �I�3C� Telephone e;1 -(i47• 6/(,/ -
OFFICE USE ONLY �l i PERMIT NO. r
TYPE OF CONSTRUCTION PLAN CHECK NO. ,
OCCUPANCY -, GROUP I�� `�� �✓ �� PLAN CHECK FEE $