HomeMy WebLinkAboutF2021-0045 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division 6^ ry 7, i . p bys
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[/Fire Sprinkler rj Fire Alarm [- Fire Misc
Associated Building Permit # � -
1. Pro,jlecct Address (Not mailing address)Floor Suite No
000
Tenant Name M A -C D /' Y I #Units
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2. Description of Work
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Use F�
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Extg Sq Ft F-1 New/Added Sq Ft Total Sq Ft �—�
Valuation $
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New F- Add F7 Alter F, Demo
#Stories
Check Appropriate Box for ApplicantlNotification
3. Owner's Name
Lash r1
i FirstF
Owner's Address
Owner's E-mail Address
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city _I �U... lVt,�/
----. ',, State
Zip Z4t.. �__. Telephone (,� /� ....-....-,.—..,.�Z/ 'z'.
F_ 4. Architect/Designer's Name Last I-
1 First Lic. No. F
Architect/Designees Address
Architect/Designer's E-mail Address
City
: State-
Zip ��' Telephonel
[ 5. Engineer's Name
Last � 1iYt�
7)Yi First Lic. No. &z �
Engineer's Address
Engineer's E-mail Address
City F- - ,-
�, State —,
Zip Telephone
F-16. Contractor's Name
Last /�� �p First I- - -"-- --', Lic. No.Z7 ClasJs�C1 (o
Contractor's Address
Contractor's E-mail Address
Zu 10
_41
City "VI (JL
State —.,
Zip [1Z / Telephoned �Cj` Z l 6
OFFICE USE ONLY
j P��,�.. PERMIT NO. r
TYPE OF CONSTRUCTION
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PLAN CHECK NO.
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OCCUPANCY - GROUP
PLAN CHECK FEE $
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