HomeMy WebLinkAboutF2021-0339 - Permit ApplicationWorksheet for Fire Permit Application4 `W`°"r
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City of Newport Beach - Building Division `_ 4 o g
Please print 3 copies Ir P3,
Associated Building Permit # I -X2ol& -423-11 r Fire Sprinkler r Fire AlarmFire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name Aief BeacA #Units
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2. Description of Work
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Use
Extg Sq Ft `i D0 ai New/Added Sq Ft Total Sq Ft 6, 00.. 0
Valuation $ 2�-0
F_ New f— Add r Alter r Demo
#Stories F
Check Appropriate Box for Applicant/Notification p� t �� �+ 1 �,n^
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3. Owner's Name Last//i7 G First
Owner's Address Owner's E-mail Address pJb CO
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City / V �f- G✓T. �,�� State I `-"' Zip <77�O_ U.. Telephone / 37S'%b?
Fi4.Arch itect/Designer'sName Last 5c��r r Ii First /q,4441&i Lic.No. F—
Architect/Designer's Address Architect/Designees E-mail Address
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City /'�! %/S', State Zip i 2— Telephone ��1 did!/,._s�{Z %
5. Engineer's Name Last First �— --- �T Lic. No. [--- —'i
Engineer's Address Engineer's E-mail Address
City _.._ State Zip F Telephone f F_
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r S. Contractor's Name Last _'""ulS� _.._ First07571 ------ Lic. No. vsyi7n Class)
Contractor's Address Contractor's E-mail Address T/
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City .8�cq State F 6W Zip R2V., Telephone 7iy_ 83 / 7j7 S
OFFICE USE ONLY PERMIT NO. ✓
TYPE OF CONSTRUCTION PLAN CHECK NO. Dv 4
OCCUPANCY- GROUP �"\� PLAN CHECK FEE $