HomeMy WebLinkAboutF2021-0311 - Permit Application�P r w F�21
41 ,nnt Fgrm; Worksheet for Fire Permit Application
Please print 3 copies City of Newport Beach - Building Division o
Associated Building Permit #
Fire Sprinkler j- Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
3 Floor j'Suite
-No—
Tenant Name Myr t _ _ 0
#Units (,--_----,
2. Description of Work
Extg Sq Ft F� New/Added Sq Ft �-------.-.- Total Sq Ft'.------'
r New I -
j Add j J Alter F_ Demo
Check Appropriate Box for Applicant/Notification
Owner's
Name Last l rvly e, tel, P � Firstr-_---
ner's Address
Owner's E-mail Address
Use
Valuation $ 2� U O
# Stories
City r -v \b..G ..._ _.. State L� Zip j�'_-_-._. Telephoned..__ _.. _.
J4-Architect/Designer's Name Last
Architect/esigners Address E�T? �- _I ,First il)`'y�
Lic. No8yZ,8C
'1! 11,7? Architect/Designer's E-mail Address
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City 17kt I E Zip eyl'�o
State SS Telephon w) 3p9 ��4L1
r 6. Engineer's Name Last - First ------
Lic. No.
-_-
Engineer's Address
Engineer's E-mail Address
City Statezip
Z P Telephoner..__..,-_---
r6. Contractor's Name Last [y UT. First
5_31,tV.i Lic. No.8'ILSS' Class Fc- -14
Contractor's Address
1447-7t L S 1 Contrraactor's E-mail Address
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City�i►qr State �' c_
/i Z P %SSS Telephone------------------
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OFFICE USE ONLY PERMIT NO.
TYPE OF CONSTRUCTION
OCCUPANCY -GROUP PLAN CHECK NO. /1
PLAN CHECK FEE $