HomeMy WebLinkAboutF2021-0420 - Permit ApplicationWorksheet for Fire Permit Application (F
,o1q,Wl
,� I-),,
Please print 3 copies City of Newport Beach - Building Division o
M21 _D420
Associated Building Permit# F-] Fire Sprinkler F, Fire Alarm F1 Fire Misc
1. Project Address (Not mailing address) Floor Suite No
7— F
Lo 3 0 5 W 13 t V- Cklf 5�0_
----------
# Units
Tenant Name Pip f,�T-
2. Description of Work
�
26 A-pvwl,0,e_-i,- rte_itlb��
-
Use
I
Extg Sq Ft New/Added Sq Ft Total Sq Ft
Valuation $
F' New F'i Add F_ -i After F- Demo
# Stories
Architect/Designees E-mail Address
City F777 .
Check Appropriate Box for Applicant/Notification
lnf^rm.f!��
F-'3. Owner's Name Last
.. I
First
1777777
Owner's Address
owners E-mail Address
�
City
Zip
State Telephone
F_ 4. Architect/Designer's Name
Last First Lic. No.
Architect/Designers Address
Architect/Designees E-mail Address
City F777 .
State TelephoneF
—Zip F
F_ 5. Engineer's Name Last
LK) First
L Lic. No. Z15 61
Engineers Address
Engineer's E-mail Address
City
State zip Telephone
F_ 6. Contractor's Name Last
First Lic. No. ass
[Z-
T
Contractor's Address
Contractors E-mail Address
rTMVF_t vevf zz)PI--,
City L-4�
L-
State CF Zip [ q-7- Telephone77 )Z, q
[ _ k 6
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $