HomeMy WebLinkAboutF2021-0462 - Permit Application0g62, Worksheet for Fire Permit Application(Fe?`WncRm
Print Form 1 I City of Newport Beach - Building Division
Please print 3 copies'
Associated Building Permit # VA 22I S Fire Sprinkler F_ Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Imp U M �v iN"P,�J � ► IF) P
Tenant Name # Units r
II 11✓/ Ib �t
2. Description of Work
Ma 2- -lil
Use
Extg Sq Ft % I �2 New/Added Sq Ft F Total Sq Ft �,q2_
Valuation $
Stories F
Add Alter (— Demo
F-New F_ Add
Check Appropriate Box for Applicant/Notification
(— 3. Owner's Name
Last I/ erw /I q Go �' First m—v 0 rC,1 J
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Owner's Address
WOw{n'e�rss E-mail Address
40- r
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City
State I ZipU Fp2. TelephoneF_�
r 4. ArchitecVDesigner's
Name Last rni First FMU__-jV—', Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
7MUTu
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City
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State I Zip Telephone I U3� AIo/yt
VY I
5. Engineer's Name
LaFirst — Lic. No.
I/� 7 'U
Engineer's Address
En ineees E-mail Address
City
State V'r Zip Telephone I L0 l lam. �(',( QzL
F_ 6. Contractor's Name
Last YPb���F— Lic No. Class /n
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Contractor's Address
ontralols E-mail Address
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City ��U
State F_ Zip Telephone 2TijI eKtZ�
OFFICE USE ONLY PERMIT NO. Y vV
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TYPE OF CONSTRUCTION
`i PLAN CHECK NO.
OCCUPANCY - GROUP
I �j /, rl I PLAN CHECK FEE $