HomeMy WebLinkAboutF2021-0216 - Permit Application- Worksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division �F
q U S
Please print 3 copies
Associated Building Permit # Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
F -
First f -----'--
Z 9 9/
Tenant Name F146T
� � C
# Units ( '
2. Description of Work
r 4. Architect/Designer's Name
Use _ ___......._'.
(�
CG..i'.I O» O -I C5% b� �. �idl� S
EMg Sq .-----_--
Ft �'
New/Added Sq Ft �_', Total Sq Ft �—
Valuation $ I�y'/��J
�� V �
F_New r Add X Alter r Demo
# Stories F
Check Appropriate Box for Applicant/Notification
Infnrmnfinn
F- 3. Owner's Name Last
First f -----'--
Owner's Address
Owner's E-mail Address
City
State I—
Zip Telephoned------
r 4. Architect/Designer's Name
Last
First — Lic. No. r
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_
Zip F—', Telephone
5. Engineer's Name Last
First F_ Lic No.
Engineer's Address
Engineer's E-mail Address
i
City �-
State F__
Zip F Telephone-----
F_ 6. Contractor's Name Last
First VMC
F/ Lic No. &02��lass C -/b
AY I
4
-c-
Contractor's Address
Contractor's E-mail Address
3�z57oCC14tJ
OEW e�LYv
VfGCiiFA® AX1S5�
City I C-11 6w oAt �
State Ca
Zip '�j ( 20,? Telephone
OFFICE USE ONLY
I >}() r �� r(j y PERMIT NO.Otil�-
TYPE OF CONSTRUCTION
U ` 1
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $