HomeMy WebLinkAboutF2022-0333 - Permit Application (3)worKSneet for Lire Permit Application
Pnnt Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # F-! Fire Sprinkler__j Fire Alarm ✓Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
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Tenant Name A/ #Units F
2. Description of Work +(
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Extg Sq Ft / /I 9 �/� / I New/Added Sq Ft Total Sq Ft
New �[�(Addd Fj Alter [l Demo , L I LA Lf
Check Appropriate Box for Applicant/Notification
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Valuation $ 13 2Z3 i
# Stories u
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❑ 3.Owner's Name Last C Q ilov sG L(C First
Owners Address Owner's E-mail Address
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City , State Zip oZZ Telephone
4. Architect/Designer's Name Last I First I Lic. No.
Architect/Designer's Address Architect/Designers E-mail Address
city P Phone State Zip Telephone
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5. Engineer's Name Last �_ First Lic No.
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Engineers Address Engineer's E-mail Address
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City I State Zip Telephone
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F—I 6. Contractor's Name Last _C First E Lic No. �I, Class
Contractor's Address Contractor's E-mail Address
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OFFICE USE ONLY V L a r 7 PERMIT NO. Z JZ O -7
TYPE OF CONSTRUCTION dl �� PLAN CHECK NO.
OCCUPANCY - GROUP L j J J PLAN CHECK FEE $