HomeMy WebLinkAboutF2022-0456 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
worKsneet Tor Tire vermlt Application
City of Newport Beach - Building Division
1. Project Address (Not mailing address)
Tenant Name
2. Description of Work
❑ Fire Sprinkler ❑ Fire Alarm Fire Misc
Extg Sq Ft F New/Added Sq Ft F77:71 Total Sq Ft
"ew ❑ Add ❑ Alter ❑ Demo
L,necic Appropriate ilsox Tor Applicant/Notification
Floor
# Units
Use
Valuation $ L
U-
,
Suite No
# Stories F7
❑ 3.Owner's Name
Last First
Owner's Address
Owner's E-mail Address
City State F7_71 Zip � Telephoned
❑ 4. Architect/Designer's Name Last First
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip Telephoned
❑ S. Engineer's Name
Last First
Lic. No.
Engineer's Address
Engineer's E-mail Address—
S
/
1./
_
City
State FEE Zip 1=1_lRJ1Y]_ 1 Telephone
❑ 6. Contractor's Name Last First / r Lic. No.
Class
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Contractor's Address
Contractor's E-mail Address
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City QS
State Zip —Telephone
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OFFICE USE ONLY
PERMIT NO.
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TYPE OF CONSTRUCTION
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%i% ` �PLAN CHECK NO. �� •Z172�I
OCCUPANCY -GROUP
��� g PLAN CHECK FEE $