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HomeMy WebLinkAboutF2021-0109 - Permit ApplicationWorksheet for Fire Permit Application City of Newport Beach - Building Division Please print 3 copies Associated Building Permit # �ire Sprinkler [Fire Alarm F_' Fire Misc 1. Project Address (Not mailing address) Floor Suite No Tenant Name Units 2. Description of Work First Use Owner's E-mail Address d yzkca �e_ �c5 WCA6S 0) A'(i CA Valuation $ 500 1- !;t Stories Extg Sq Ft New/Added SqFt - Total Sq Ft F - F New Alter F-,, Demo Check Appropriate Box for Applicant/Notification F73. Owner's Name Last First Owner's Address Owner's E-mail Address City State Zip FTelephone_ 4. Architect/Designer's Name Last First F Lic. No. Architect/Designees Address Architect/Designer's E-mail Address City State Zip Telephone F_ 5. Engineer's Name Last First Lic. No. F_ Engineer's Address Engineer's E-mail Address City State Zip Telephone Contractor's Name LasI Xt First Lic. No. E�3,qo lass .... -1 - F CV_ Contractor's Address elf e_ 9f-r)�-CCAi On, XTX, Contractor's E-mail Address (OL, City State ..J zip TelephoneF95) OFFICE USE ONLY PERMIT NO. TYPE OF CONSTRUCTION PLAN CHECK NO. o�. tot-( OCCUPANCY- GROUP PLAN CHECK FEE $ dr-AIR-M.S. -a 1w wle f Wk CL�i