HomeMy WebLinkAboutM2004-0012WORKSHEET FOR BUILDING / FIRE PERMIT APPLICATION
CITY OF NEWPORT BEACH HARBOR RESOURCES DIV.
of =AQ= 001KIT nO TVDC: (9 BUILDING DEPARTMENT CITY OF NEWPORT BEACH
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
FLOOR
SUITE NO.
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OWNER'S E-MAIL ADDRESS
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CITY STATE ZIP
LEGAL DESCRIPTION
No. UNITS
LOT BLOCK TRACT
LIC. NO.
2. DESCRIPTION OF WORK tZ USE
# OF STORIES
—VALUATION$ Q
NEW' F� ADD ALTER DEMO SQ FT -1 S__C)
maA-�tvklc� Cm (NEW/ADDED/EXTG)/
.Check Appropriate Box
3. OWNER'S NAME LAST
FIRST
OWNER'S ADDRESS
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OWNER'S E-MAIL ADDRESS
I
CITY STATE ZIP
PHONE NO.
4. ARCHITECT/DESIGNER'S NAME LAST
FIRST
LIC. NO.
ARCHITECT/DESIGNER'S ADDRESS
ARCHITECT/DESIGNER'S E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO.
* 5. ENGINEER'S NAME LAST
FIRST
STATE LIC. NO.
I
ENGINEER'S ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO.
* 6. CONTRACTOR'S NAME
BUSINESS LIC.
,No.
STATE LIC.
Class
CONTRACTOR'S ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE
ZIP
PHONE NO.'
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
PERMIT.NO.
PLAN CHECK NO.
PLAN CHECK FEE $
PLAN CHECK ENG.
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