HomeMy WebLinkAboutX2021-0710 - Permit Application (2)VYh7rkshe�:�'for`Fire Perrtii�App4it;ation o� m
Print Form' City of Newport Beach - Building Division
Please print 3 copies (` f �� ' Q 7' 0 Foa
Associated Building Permit # �— j Fire Sprinkler r -,Fire Alarm r Fire Misc V
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name N I p # Units F
2. Description off Work
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�i V- e S p ri �Lcn/Use
City F_,�Vi Wle
Valuation $ � IT31 c'I'll
Extg Sq Ft I Lj f C•1 ZkA New/Added Sq Ft I_ Total Sq Ft
Last tdv' First JI1w..S Lic. No. FC 12'33(0
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# Stories � IfJ
F- New F*Add F Alter r Demo
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Check Appropriate Box for Applicant/Notification
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r 3. Owner's Name Last
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Owner's Address
Owner's E-mail Address
City F_,�Vi Wle
State c—A ZiP a,2-01-7 Telephone 20, 2qr C)
F-4.Architect/Designer'sName
Last tdv' First JI1w..S Lic. No. FC 12'33(0
Architect/Designer's Address
Architect/Designees E-mail Address
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City 1vv9VV- _ _
State CA _ ZiP t ` { % Telephone l � Z4 i `IGca)
5. Engineer's Name Last
I 5AV L - 17 First PWS t lF�J Lic. No.F44a�� L�
Engineer's Address
Engineer's E-mail Address
-LM E. N1_rziwL�_Ave
City (�w, �
State 1 4?4 Zip ) 7Lg0_ Teleph"
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F_ 6. Contractor's Name Last]-c,�`First Lic. No.Class r�,
Contractor's Address
Contractor's E-mail�Address
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c _ OBt57 f-_& tLG /(1T,Q-T7D
City
State O Zip Telephone
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $