HomeMy WebLinkAboutF2021-0491 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies q
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Associated Building Permit UNt Fire Sprinkler F, Fire Alarm Fire Misc
1. Project Address Not mailing address) Mcwuive No
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Tenant Name11b77#M"7v$W # Units
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2. Description of Work 4H devfce(� to im .- q2 demjq�
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Use
Extg Sq Ft OCI j Now/Added Sq Ft Total Sq Ft i
Valuation$ \ R 11
New V_ Add F Alter F_ Demo
# Stories
Check Appropriate Box for Applicant/Notification
F-'3. Owner's Name Last
First
Owners Address
Owner's E-mail Address
City
State
Zip TelephoneF
e4. Architect/Designer's Name Last
First Lic. No.
Architect/Designers Address
Architect/Designer's E-mail Address
City
State
---- ----- -
zip F____7 TelephoneF77777
5. Engineer's Name Last
First F777777 Lic. No.
III
Engineer's Address
Engineers E-mail Address
City
State
Zip Telephone
'6. Contractor's Name Last FirstdLic. No Cl1d assIFJ (Ab
Contractors Address
Contractor's E-mail Address
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14600 1\J - Hy- bl
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City
State FCA--
Zip [Cl Telephone q (),5 -
06—
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $