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Print Form `
Please print 3 copies
9
Worksheet for Building/Fire Permit Application
City of Newport Beach
Building Department
1. Project Address (Not mailing address)Floor
Suite No
Owner's Address -J
Owners E-mail Address
F__
Legal Description
Lot F BlockF—
Tract # Units F
2. Description of Work
Architect/Designers Address
Architect/Designers E-mail Address
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Use Moor Boat
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4,, C_1 /421 O61C714e
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Engineers Address
Engineers E-mail Address
12500 Via Cabrillo Marina #200
# Stories
Tenant Name if Commercial
`— 6. Contractor's Name Last Swift Slip First Lic. No. F797052 ClasslA
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Valuation $ 2 6�oonp
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Alter (— Demo j_7 mwi n .r
bhswiftslip@sbcglobal.net
Sci Ft (new/add/extended)
Check Appropriate Box for Applicant/Notification Information
— 3. Owner's Name Last sof �j LY
First' mf
Owner's Address -J
Owners E-mail Address
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C.ty N StateI
Zip Telephone
— 4. ArchitecUDesigner's Name Last— First Lic. No.
Architect/Designers Address
Architect/Designers E-mail Address
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City � Slate Fu
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Zip l- Telephone—
,— S. Engineer's Name LastBazley
First.Tim Lic No. IC50019
Engineers Address
Engineers E-mail Address
12500 Via Cabrillo Marina #200
City ISan Pedro State CA
Zip— Telephon '310-548-3132
`— 6. Contractor's Name Last Swift Slip First Lic. No. F797052 ClasslA
Contractors Address
Contractors Email Address
12027 Placentia Ave
bhswiftslip@sbcglobal.net
City Costa Mesa State (CA
Zip 92627 Telephon '949-631-3121
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
PLAN CHECK FEE $
OCCUPANCY- GROUP
PLAN CHECK ENG.
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