HomeMy WebLinkAboutF2021-0250 - Permit ApplicationPrint Form —,,-,,-,Worksheet
GZSWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies 2221640 (/ vl f fl'NS I ' 1 Qf
Associated Building Permit # -1 ! 0 1 Fire Sprinkler F_ Fire Alarm F— Fire Misc
1. Project Address (Not mailing address)
Floor
Suite No
f/Owner's E�-}mail Addresjs,,
City �� !,��� f _ State ���
n�a�{,'y
Zip ice?. � Telephone �yv/, a'7 . �7o7
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Tenant Name I WTI
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# Units
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2. Description of Work
F_ 5. Engineer's Name Last '
First I Lic. No.
Engineer's Address
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Engiinn�eer'sE-mailAddresss
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94At °XJI �r S l
Use ��`
City��(�f �,� i State
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Extg Sq Ft-',
New/Added Sq FtTotal Sq Ft t�t ,
o�-
Valuatin $���t
F_ New F_ Add j
Alter r Demo
#Stories
2
PERMIT NO. It
Check Appropriate Box for Applicant/Notification
L.F.. w4:..
F_ 3. Owner's Name Last M I b %
First FWeCio
Owner's Address'9'�t
f/Owner's E�-}mail Addresjs,,
City �� !,��� f _ State ���
n�a�{,'y
Zip ice?. � Telephone �yv/, a'7 . �7o7
s r i r
(-, 4. Architect/Designer's Name Last i �i� �VA+ iir✓st (1 I/1 i� � Jam' Lic. No.l103Lr'1 to'
/ _+ 1
US/�
�Addressly
Archite esigner's Address
J �p
VOW a uc/ 1 u CJ 1 L '�✓ V. D�
Architect/Designer's �E-mail
( �+,�
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City(���;� ��'�f% i_... ',. State —',,.
Zip (11'l_ Telephone I 8'30 l i r,l—
F_ 5. Engineer's Name Last '
First I Lic. No.
Engineer's Address
K?
Engiinn�eer'sE-mailAddresss
(q�jj
94At °XJI �r S l
n��q
l
City��(�f �,� i State
Zip %�f✓�, v. Telephone
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F_ 6. Contractor's Name Last .qi4ff 1 n Lic. No. ' ,3i_W Class i �1
Contractor's Address
Contractor's E-mail Address
OV ` 6, `amu L tia"
City V l/Ll t� Stater
Zip f� Telephone � �q2� J 6� 1) ,«I„ 2
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OFFICE USE ONLY
2
PERMIT NO. It
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $