HomeMy WebLinkAboutF2022-0163 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
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Associated Building Permit # I Fire Sprinkler ❑ Fire Alarm J Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name X- q. 61 74- — # Units
2. Description of Work
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Extg Sq Ft 1r-700 New/Added Sq Ft Total Sq Ft
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Valuation $
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New Add Alter [Demo
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Check Appropriate Box for Applicant/Notification
[713. Owner's Name Last �— J First
Owner's Address Owner's E-mail Address
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City State Zip F Telephone
(- 4. Architect/Designer's Name Last �— First F Lic. No.l j
Architect/Designer's Address Architect/Designer's E-mail Address L
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City � — _ _ —� State �—; Zip F�, Telephoned
_' 5. Engineer's Name Last _ First
Lic. No. i
Engineers Address Engineer's E-mail Address
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City _— — State e—' Zip F J Telephone
(k5. Contractor's Name �_Last, /kms First �/ Lic. No. �"` �SC1/5' Class
Contractor's Address Contractor's E-mail Address
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City 41r5n i1ye y, _. State �_ Zip l�.,z(nS(v Telephone yy�1ZL2i', 1/y"
OFFICE USE ONLY PERMIT NO.
TYPE OF CONSTRUCTIONPLAN CHECK NO.
OCCUPANCY - GROUP LAN CHECK FEE $
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