HomeMy WebLinkAboutF2021-0231 - Permit ApplicationPrint Foam_ Worksheet for Fire Permit Application 0-43
City of Newport Beach - Building Division
Please print 3 copies!!�
Associated Building Permit # >eW F1�21 — Gj b[- Fire Sprinkler r?,� Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
iw23, 1a.-6,
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Tenant Name _ # UnitsI (Q
2. Description of Work
,ce Alarm "Sprink(er f)1an-k{(1
Use
Extg Sq Ft yc� New/Added Sq Ft �p� t Total Sq Ft 3 3
Valuation $ fad('
New F_Add F_Alter r Demo
# Stories
Check Appropriate Box for Applicant/Notification
3.Owner's Name Lastl
4e<_
First`R o/\,
Owner's Address
Owner's E-mail Address
S b=vc
corphams,C&
City r`�fG� d'�
State FC,4
Zip q,/ (,o Telephone qqq 7:57-3/-16q
r 4. Arch itectIDesigner's Name
Last IVA_ First F Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �—
Zip - Telephoner
C 5. Engineer's Name Last
First r----_— Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State F------
Zip F Telephoner--.--
F_ 6. Contractor's Name Last
i�cYfs
First Lic. No. Class r
M y53 _ L_f 0
Contractor's Address
Contractor's E-mail Address
0/315
City
State C ......
ZiP q rD.. Telephone gSZ.078-.bo?SSS
OFFICE USE ONLY
PERMIT NO. DZ5 1
TYPE OF CONSTRUCTION
PLAN CHECK NO. 1
OCCUPANCY- GROUP
PLAN CHECK FEE $