HomeMy WebLinkAboutF2021-0083 - Permit ApplicationWorksheet for Fire Permit Application W� o
City of Newport Beach - Building Division N o
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Associated Building Permit# T Fire Sprinkler [ Fire Alarm
1. Project Address (Not mailing address) Floor << Suite No
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IBA
Tenant Name .i1/OdL (Jny...... --- 5 �C'__.� Jei
2. Description of WorkUse
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E tg Sq Ft New/Added Sq Ft I Total Sq Ft
Valuation $)
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j� New Add Alter C Demo
# Stories
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Check Appropriate Box for Applicant/Notification
I -i 3. Owner's Name Last First
Owner's Address Owner's E-mail Address
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City State �— Zip F7777 TelephoneF_—
4. ArchitectlDesigner's Name Last I FirstF— Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City State Zip Telephone
�l 5. Engineer's Name Last First First [� �V� Lic. No.��
Engineer's Address Engineer's E-mail Address -
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City }�/��(l(piC" State Zip �,�&�,b%-r� Telephone1f�V
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( 6. Contractor's Name Last l%,�L Flrst Sign/ Lic. No.�,R)� Class56
Contractor's Address Contractor's E-mail Address
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City
(� Zip G ,16 Telephone p,3
OFFICE USE ONLY �J PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP" j �.y c PLAN CHECK FEE $
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