HomeMy WebLinkAboutX2018-3876 - Permit Application (4)Print Form Vff�>�G� hoW for f ore 6��ervyM Apgpflm-Aeon ��EWPOR�
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City of Newport Beach - Building Division -
Please print 3 copies ` D ` ` ?( ca<�ORHP
Associated Building Permit # r'- Fire Sprinkler r` Fire Alarm (— Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name # Units �a
2. Description of Work
Extg Sq Ft New/Added Sq Ft Total Sq Ft
j— New F Add j_ Alter j-` Demo
Check Appropriate Box for Appilea nt/Notification
Use I
Valuation $
# Stories
F 3. Owner's Name Last F
First
Owner's Address
Owner's E-mail Address
City
State
Zip Telephoned--
F 4. Architect/Designer's Name
Last
First I Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State ��
Zip �Telephone
F 5. Engineer's Name Last
First Lic. No. F
Engineer's Address
Engineer's E-mail Address
City
State
Zip—� Telephone
r 6. Contractor's Name Last First Lic. No. 7 ��°d{, Class!
Contractor's Address
Contractor's E-mail Address
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City J I "t.- �K
State �.
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Zip Z 7 D cf Telephone —!� -33 " 4171
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $