HomeMy WebLinkAboutF2022-0038 - Permit Application (3)i wc( �
Worksneet for Fire Permit Application
Print Form' City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit #
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r Fire Sprinkler F_ Fire Alarm I— Fire Misc
1. Project Address (Not mailing address)
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Tenant Name 7?111,/;1& / nhn y?)W hv7 Uh c7DO/
2. Description of Work vl ✓
Extg Sq Ft New/Added Sq Ft f )— ;/ Total Sq Ft
r New F— Add F/ Alter r Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units F—
Use
Valuation $
# Stories
F_ 3. Owner's Name
Last .r� f
First
Owner's Address
Owner's E-mail Address
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City I ezh State
Zip Telephone
i— 4. Architect/Designer's
Name Last
First Lic. No. F—
Architect/Designees Address
Architect/Designees E-mail Address
City
State
Zip i Telephoned
r 5. Engineer's Name
Last �
First F_ Lic. No.
Engineer's Address
Engineer's E-mail Address
City I
State F_
Zip F Telephoned
G/G. Contractor's Name
LastO,,i,7/ j/_ First �� Lic. No. F Class
Conttrractor's Address
Contractor's E-mail Address
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City �� �� ��_ State I �.JY
Zip 1 /OUd ./ Telephone' fy- . (nY3
OFFICE USE ONLY
PERMIT NO. rZG22-(x)35
TYPE OF CONSTRUCTION
PLAN CHECK NO. (j9c(�Z022
OCCUPANCY - GROUP
ci zols- 06(( PLAN CHECK FEE $ 153 . OO
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