HomeMy WebLinkAboutF2021-0229 - Permit Application:V�20z - a?,,m 17-01 WtwVV vw
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pnntVF E Worksheet for Fire Permit
Please print3 copies City of Newport Beach Buildin AppitCatlOrl
41EW�
Building Division �
Associated Building Permit # �Z , °
4-1
7. Project Address (Not mailing address) r Fire Sprinkler Fire Alarm r Fire Misc
/dO,/ y 113, Floor
0Gti Lane Suite No
Tenant Name - - �----
2. Description of Work # Units
s
Ft're 1 �T'46f ,M 51Drir?k-1 er MOnddrlY1q /e tv7 Use _ V
4
Ext S Ft ( a r�
_.� New/Added Sq Ft 70 Total Sq Ft
�-- Valuation $
[� New [i Add
r Alter ( Demo
Check A p 1 t # Stories
ppro riate Box for Applicant/Notification v 5
3.OwneName r's N
r Last
Owner's ���e �
nitner's Address - - -- - First I C
J a, y�, ,� _ �-'�_ J Owner's E-mailAddress
city
State C}( Zipj'��----
r14. Architect/Designer's Name of �{�yQ Telephone 9� - 7S7 ,`3el2ZI
Last NA
ArchitecNDesigner's Address - First r--_--
Lic. No.---
Architect/Designer's E-mail Address
city --_.
I Zip L.. Telephoner_
EnEngineer's5. Engineer's Name Last A0
Address - - - - _ First f --.— —�—
Lic. No.
Engineer's E-mail Address
City
17
-- I
6. Contractor's Name Last , /� Zip Telephonel_—
Contractor's Address First T/711 -- Lic No.
c�3363 class CIO
Contractor's E-mail Address
city Corenc,
Zip _
�tc2, ® Telephoner,711,11,11
sl,���S
OFFICE USE ONLY
TYPE OF CONSTRUCTION PERMIT NO.
OCCUPANCY -GROUP 7 PLAN CHECK NO. C) S
U Q CO a (��j PLAN CHECK FEE $ ------
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