HomeMy WebLinkAboutX2007-1997 - Permit ApplicationWORKSHEET FOR BUILDING / FIRE PERMIT APPLICATION ( 1' '—
CITY OF NEWPORT BEACH
BUILDING DEPARTMENT
PGtASt 1''KIN I OK I T rc
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
C WD 1O1 (ti
4% 2
q2C,
FLOOR
SUITE NO.
LEGAL DESCRIPTION
LOT 1:1-2,& BLOCK 0((
TRACT
Sl7
No. UNITS
u 2. DESCRIPTION OF WORK gpeg(JS pej b11 Gl- C€ LM F>
tv_rt.g_ttficut GA >'4 met E-1
p toctc Vru-► i -t cpS
NEW ❑
ADDX
ALTER ❑
DEMO ❑
USE r 1-1-
# OF STORIES
VALUATION $ Z17boJOCO
SQ FT (D i 4",5
(NEW/ADDED/EXTG)
G' ' n9./1./I vN..aaaw vv.. ....• • .r'r..--..._
FIRST
' OWNER'S NAME LAST
OWNER'S ADDRESS
- W)t
OWNER'S E-MAIL"ADDRESS '= f
L-Y4-i1,�b""z;\sp ,f.Ar 1
,
CITY STATE
MO 1902(...H CA\
ZIP
C7(2&61)
PHON NO.
(4')1L4 A4
N4. ARCHITECT/DESIGNER'S NAME LAST
� V l
t��r a
tab ttoP
�`-�'FFFIIIRRSST� V`A1
aLIC. NO.
��(��
ARCHITECT/DESIGNER'S ADDRESS
1421V, %c L$ (Re- a. 4/
ARCHITECT/DESIGNER'S E-MAILC' ADDRESSI
4-4k- ibt9 t'/ic - (. )
CITY STATE
1i`� icy%t- GA
ZIP
q(
PHONE NO.
E3o 413- 6
`). ENGINEER'S NAME '(.GPfP LAST
OiVagi HCORLA
FIRST
RAJ-1
STA LIC. NO.
S S65 2
ENGINEER'S AD RESS
(oo$10 '% 2 pRoe i scv'CF - 1
ENGINEERS E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO.
(34') 5- IC 3�
❑ 6. CONTRACTOR'S NAME
1Cerik t?$ Co ►.15Te_vc,2 t sJ
BUSINESS LIC.
$.1' a 30 f 2 (o 7
STAT LIC.
No. 199 $ I Co Class 5
CONTRACTOR'S ADDRESS
l0/ 3s' Ci4-R.y Ate=
CONTRACTORS E-MAIL ADDRESS
tnf66) kempbwas.com
CITY STATE
5 f34-1711 /. Spz,'.' S CA 9b(.9r7.
ZIP
PHONE NO.
5ro2 234, 5'000
OFFICE USE ONLY f r 63a1 ZI I5 - ?j (-o
i
TYPE OF CONSTRUCTION (Z v31 7 f gotu)00G
�5 PERMIT NO.
2 PLAN CHECK NO.
PLAN CHECK FEE $
PLAN CHECK ENG.
�aa
' \f& — U od.40
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OCCUPANCY - GROUP t ..( �D
t-orms\Bldg_applIca tion