HomeMy WebLinkAboutF2021-0571 - Permit Application' 'P�infEorm
Please print 3 copies
vvorKsneet ror rire vermit Application
City of Newport Beach - Building Division 2
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Associated Building Permit #
PT"Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
0 F_7
521
Tenant Name # Units
2. Description of Work
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Use
Valuation$
Extg Sq Ft New/Added Sq Ft Total Total Sq Ft
New ❑Add ❑Alter ❑Demo
# Stories F7
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last
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Owner's Address
Owner's E-mail Address
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City ^ ,�
I State Zip I t/T 111 i� 1 hone ',FPS - Rv
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❑ 4. Architect/Designer's Name
Last hO�le),/, First )n cf � Lic. No.
ArchitectlDesigner's Address
Architect/Designer's E-mail Address
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City
State Zip Telephone
❑ 5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State �� Zip Telephoned
❑6. Contractor's Name Last
First Lic. No. �— Class —I
Contractor's Address
Contractor's E-mail Address
City
State I Zip Telephone
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. 2�b �GaYj
OCCUPANCY -GROUP
PLAN CHECK FEE $