HomeMy WebLinkAboutX2007-1463 - Permit Application (4)WORKSHEET FOR BUILDING / FIRE PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DEPARTMENT
94A;
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT sA MAILINGADDRESS) /� FLOOR SUITE NO.
LOT /5 BLOCK TRACT 3S-/ y
2. DESCRIPTION OF WORK 14PJ9%✓%0 .1-i d,�6 I-1014it9
��b� / ; z llr✓ C�
Al
NEW/,PII ADD j ALTER DEMO6 l�a
Check<ADDrooriate Box for ADDlicant C ,n .74 3
OF STORIES
ALUATION $
ITS
❑ 3. OWNER'S NAME
LAST
4-6
' j
J4-Lro-°J
OWNER'S ADDRESS
* �Y Ce / 7 r`P 1? ,1r
OWNER'S E-MAIL ADDRESS
CITY /
STATE
ZIP
PHONE NO.
❑ 4. ARCHITECT/DESIGNER'S
NAME �LAST
Oct,
FIRST
LIC. NO.
ARCHITECT/DESIGNER'S
ADDRESS
ARCHITECT/DESIGNER'S E-MAIL ADDRESS
3 & � 9- co
1116 > vD 2
CITY
STATE
ZIP
PHONE NO.
y—
yy
❑ 5. ENGINEER'S NAME
LAST
FIRST
STATE LIC. NO.
k
(f— 2 J
ENGINEER'S ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO.
6. CONTRACTOR'S NAME
BUSINESS LIC.
STATE LIC.
No. Class
CONTRACTOR'S ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
OFFICE USE ONLY
5"a L_,
PERMIT NO.
TYPE OF CONSTRUCTION
—Pik 1�
_
PLAN CHECK NO.
PLAN CHECK FEE $
OCCUPANCY- GROUP
PLAN CHECK ENG.
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WORKSHEET FOR BUILDING / FIRE PERMIT APPLICATION
056,
CITY OF NEWPORT BEACH
.PLEASE PRINT OR TYPE
BUILDING DEPARTMENT
1. PROJECT ADDRESS (NOT MAILING ADDRESS) r
OOR SUITE NO.�
�
No.
I LOT / `) BLOCK TRACT J✓
2. DESCRIPTION OF WORK 16b 0 6- 4-7 ®; j USE
r
y
# OF STORIES
mg2, ■I
ALTER DEMO ❑
Check ADDroariate Box for Annlicant
VALUATION $ J- crux
SQ FT J(0 0'
3. OWNER'S NAME LAST r FIRST /
ZDej�[ loj J�®lam
OWNER'S ADDRESS
t- 2� / 7 "7,/ro /O/Z--
OWNER'S E-MAIL ADDRESS
CITY STATE% ZIP
v 7�
PHONE NO.
❑ 4. ARCHITECT/DESIGNER'S NAME LAST FIRST
fl -
LIC. NO.
�
(fy /7i
ARCHITECT/DESIGNER'S ADDRESS
ARCHITECT/DESIGNER'S E—MAIL ADDRESS
CITY / STAT ZIP
fT
PHONE NO.
5. ENGINEER'S NAME LAST FIRST
L f� B
TATE LIC. NO.
ENGINEER'S ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
i✓r %� ��.- L --- % 2-6 6-o
PHONE NO.
l 2�1-6 /4�1
6. CONTRACTOR'S NAME
BUSINESS LIC.
STATE LIC.
No. Class
CONTRACTOR'S ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE 7 `h�a ZIP
PHONE NO.
' ICE USE ONLY APR 0 2005 (?�
PERMIT NO.
OF CONSTRUCTION PLAN CHECK NO.
°i 3'y CF �NEWPOR1 8EAU, i PLAN CHECK FEE $ .... ,�,
'IPANCY - GROUP PLAN CHECK ENG.