HomeMy WebLinkAboutF2022-0471 - Permit ApplicationvvorKsneet Tor i-ire rermlt Application
❑Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # ❑�Y _T Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
�-Coc) pt�"z,1P 7
Tenant Name i,� 1 j`Y f ` c p?j�iZZ�02� # Units
2. Description of Work �07i7i - Q�i
Use
� Valuation $ 3 r�
Extg Sq Ft New/Added Sq Ft �� Total Sq Ft
# Stories
❑ New ❑ Add [ Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last
J First
Owner's Address
Owner's E-mail Address
City J State Zip
Telephone
❑ 4. Arch itect/Designer's Name Last __
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City ❑ State J Zip
_ i Telephone
5. Engineer's Name Last .tJ J First /2f.� Lic.No.F
Engineer's Address
Engineer's E-mail Address
i
2 g� r U,.y�ye,,, � I`31./), _�
i y �e 61 u s. C
Zip
City S�� H �, A y y _� StateF-77
`j Z7a y J Telephone
❑ 6. Contractor's Name Last V !-'�'r� rr� f. First17 Lic. NoN�� Class
Contractor's Address
Contractor's E-mail Address
.mac
29�i 1.�/�'�tirkr�v'' �v'� h``/�
�rr�l' ly�x�ir�1✓S, CQ, �r� - --J
City Sc �lyv State Zip �2T0 J Telephone��
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $