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WORKSHEET FOR BUILDING / FIRE PERMIT APPLICgA%R RESOURCES DIV.
CITY OF NEWPORT BEACH CITY OF NEWPORT BEACH
BUILDING DEPARTMENT
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1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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SUITE NO.
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OWNER'S E-MAIL ADDRESS
CITY
LEGAL DESCRIPTION
ZIP
No. UNITS
LOT BLOCK
TRACT
LIC. NO.
2. DESCRIPTION OF WORK
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# OF STORIES
VALUATION $
ALTER F-1 DEMO SQ FT
Check Appropriate Box for Applicant
Ei 3. OWNER'S NAME
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OWNER'S M5pRF$S
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OWNER'S E-MAIL ADDRESS
CITY
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ZIP
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F] 4. ARCH ITECT/DESIGNER'S NAME LAST
FIRST
LIC. NO.
ARCH ITECT/DESIGNER'S ADDRESS
ARCHITECT/DESIGNER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. ENGINEER'S NAME
LAST
FIRST
STATE LIC. NO.
ENGINEER'S A IIRFESS
ENGINEER'S E-MAIL ADDRESS
STATE
ZIP
PHONE NO.
F] 6. CONTRACTOR'S NAME
BUSINESS LIC.
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CONTRACTOR'S ADDRrss
CONTRACTOR'S E-MAIL ADDRESS
CITY
STAT���
ZIP
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OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEE $
PLAN CHECK ENG.
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