HomeMy WebLinkAboutF2021-0268 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies F202r-
11,02 9
Associated Building Permit# Fire Sprinkler X,' Fire Alarm _,, FireWisc
1. Project Address (Not mailing address)
FloorS ufte No
FI.
Tenant Name
Architect/Designers Address
# Units
2. Description of Work
State Zip I Telephone
s
Use
Engineer's Address
Engineer's E-mail Address
Wy,
City F_-/rtmAA?
State L TK Zip[ V Telephone[r Ile
FJ6. Contractor's Name Last
LIC. NO. F7:7] ClassF_j
Valuation $
Extg Sq Ft New/Added
Sq Ft Total Sq Ft
St : ate F_71 -Zip F-2 T'e lephone
OFFICE USE ONLYTawwk
PE I RMIT NO.:
# Stories
New Add Alter
Demo
PLAN CHECK FEE $
Check Appropriate Box for Applicant/Notification
F] 3. Owner's Name Last FJIV- 1P rst
JAX� 65?AJVM�r
Owner's Address Owners E-mail Address
City State Zip Telephoned
rj4. Arch itect/Designer's Name Last First Lic, No.
Architect/Designers Address
Architect/Designer's E-mail Address
City
State Zip I Telephone
❑ 5. Engineer's Name Last First Lic. No.
Engineer's Address
Engineer's E-mail Address
Wy,
City F_-/rtmAA?
State L TK Zip[ V Telephone[r Ile
FJ6. Contractor's Name Last
LIC. NO. F7:7] ClassF_j
Contractor's Address
Contractor's E-mail Address
city
St : ate F_71 -Zip F-2 T'e lephone
OFFICE USE ONLYTawwk
PE I RMIT NO.:
TYPE OF CONSTRUCTION
q?_� PLAN CHECK N0.
OCCUPANCY- GROUP
PLAN CHECK FEE $