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WORKSHEET FOR BUILDING / FIRE PERMIT APPLICATION
CITY OF NEWPORT BEACH
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BUILDING DEPARTMENT
1 PROJECT ADDRESS (NOT MAILING ADDRESS)
FLOOR
SUITE NO.
., A L i3o✓ C ov-S 6,4 oo*
LEGAL DESCRIPTION
No. UNITS
LOT BLOCK TRACT
2. DESCRIPTION OF WORK Tn544 11 41'evul 35` X 6 t �� USE e5S FaA; -
A,
b 6 41- Z # OF STORIES
NEW F� ADD • ■
9
• •: • • . 'i • • 611011 .
lim
VALUATION $ 00
SQ FT
(NEW/ADDED/EXTG)
3. OWNER'S NAME yy LAST FIRST
av D/s V"-, C eA C bo � 156v,-S � ` C t r
OWNER'S ADDRESS
jFo4 ci,�v S
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
/1/ 5 Cam}- 1Zt,
PHONE NO.
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4. ARCHITECT/DESIGNER'S NAME LAST FIRST
NO.
ARCHITECT/DESIGNER'S ADDRESS
ARCHITECT/DESIGNER'S E-MAIL ADDRESS
CITY STAT-E-" ZIP
PHONE NO.
5. ENGINEER'S NAME ��� LAST FIRST
STATE LIC. NO.
ENGINEER'S WbDRESS
~
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
6. CONTRACTOR'S NAME
- % i
BUSINESS LIC.
� rf% I/ ' -e -7 3 y
STATE LIC.
No. 717 d 372 Class 14
CONTRACTOR'S ADDRESS M1 /
(9 Z 7
CONTRACTOR'S E-MAIL ADDRESS
CITY STATE (_ ZIP
PHONE NO, 3 f
OFFICE USE ONLY rrAA-- ,N�
�� � i'rlu��,.,
�,P- ee& PERMIT NO. #'
TYPE OF CONSTRUCTION PLAN CHECK NO.
PLAN CHECK FEE $
OCCUPANCY- GROUP PLAN CHECK ENG.
orms a aoo ication 8/27/04
Mal) uutpul
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MIMINIVIIER
� .1. ` 1, C;ity of Newport Beach
..1 1 I" IE 3300 NEWPORT BOULEVARD
OF NEWPORT BEACH, CALIFORNIA 92660
ACCOUNT
FINANCE DEPT. 714-673-2110
PIER ADMINISTRATION:
CARRIAGEO- MArLE
—T 3�339 S ALLPoRT AVE.
y ��ANdTA r E SPR CA 90670
1O11"o00Ja1
ORIGINAL RETAIN FOR
ANNUAL' ADMINISTRATION F'EE
,J
SALANCE
STATEMENT DA-T f_
03,'a1-74
YOUR RECORDS
81000
s10,cc)
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V
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rjTAPHI�' SCALE
IN F',FE-,r
i 78,2t
VIC;N17Y SKETCH
NQWPORT 5AY, CALIFORNIA
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