HomeMy WebLinkAboutF2021-0018 - Permit ApplicationVoir lire, Kermit Application
Print Form
City of Newport Beach - Building Division
Please print 3 copies 001 :
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Associated Building Permit # • r" Fire Sprinkler F_ Fire Alarm j— Fire Misc
1. Project Address (Not mailing address)
Tenant Name I �;,( (Trc.4 C �`� + a � < 1' v 6 (
2. Description of Work
Extg Sq Ft New/Added Sq Ft Total Sq Ft
(— New r' Add Alter j— Demo
Check Appropriate Box for Applicant/Notification
I— 3. Owner's Name Last I First F_
Owner's Address Owner's E-mail Address
Floor Suite No
# Units F
Valuation $ I/o 00
# Stories
City I State F_ Zip ['� �- Telephone_
F 4. Architect/Designer's Name Last 05 5 First �_Vw—^ - Lic. No.
Architect/Designer's Address Arch itect/Designer's E-mail Address
City I State F— Zip Telephone
5. Engineer's Name Last First — Lic. No.
Engineer's Address Engineer's E-mail Address
City State F Zip Telephone f --
,K6. Contractor's Name Last �( , First TVV� Lic. No. 7 - Class �- 1co
Contractor's Address Contractor's E-mail Address
City I _)c n ^f /-�� State I L " Zip 92C f 7�Telephone
OFFICE USE O LY �:�r ,l PERMIT NO. '� l - 00
TYPE OF CON TRUCTION'% �_ / PLAN CHECK NO.
OCCUPANCY - GROUP l 1 /)
(/�/i °��''%�� PLAN CHECK FEE $
Extg Sq Ft New/Added Sq Ft Total Sq Ft
(— New r' Add Alter j— Demo
Check Appropriate Box for Applicant/Notification
I— 3. Owner's Name Last I First F_
Owner's Address Owner's E-mail Address
Floor Suite No
# Units F
Valuation $ I/o 00
# Stories
City I State F_ Zip ['� �- Telephone_
F 4. Architect/Designer's Name Last 05 5 First �_Vw—^ - Lic. No.
Architect/Designer's Address Arch itect/Designer's E-mail Address
City I State F— Zip Telephone
5. Engineer's Name Last First — Lic. No.
Engineer's Address Engineer's E-mail Address
City State F Zip Telephone f --
,K6. Contractor's Name Last �( , First TVV� Lic. No. 7 - Class �- 1co
Contractor's Address Contractor's E-mail Address
City I _)c n ^f /-�� State I L " Zip 92C f 7�Telephone
OFFICE USE O LY �:�r ,l PERMIT NO. '� l - 00
TYPE OF CON TRUCTION'% �_ / PLAN CHECK NO.
OCCUPANCY - GROUP l 1 /)
(/�/i °��''%�� PLAN CHECK FEE $
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