HomeMy WebLinkAboutF2023-0310 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
lglq
Tenant Name
2. Description of Work
1svS'A1144Ic CPA
W/ 3&, rkads- .
Extg Sq Ft F New/Added Sq Ft �— Total Sq Ft r—
New r Add r' Alter r' Demo
V r MUR .Appropriate MOX Tor Applicant/ INotitication
Floor Suite No
I
# Units I
Use
Valuation $
# Stories I
F_ 3. Owner's Name
Last First F—
Owner's Address
Owners E-mail Address
City
State �— Zip F— Telephone—
r' 4. ArchitectlDesigner's Name Last First F_ Lic. No. �—
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City I
State �— Zip I Telephone—
r 5. Engineer's Name
Last First F_Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City �—
State �— Zip F_ Telephoned
i�6. Contractor's Name Last
; /T,9 First �;ky Lic No. 0M/T Class
Contractor's Address
Contractor's E-mail Address
City /44;G �C�c
State C Zip C��(o$7o Telephone e4q)���,-)I y�
OFFICE USE ONLY
,1�2� PERMIT NO. r2023 - 0 ? 10
TYPE OF CONSTRUCTION
PLAN CHECK NO.
9.WU_2_- 17-71-U-1
OCCUPANCY - GROUP
PLAN CHECK FEE $