HomeMy WebLinkAboutF2022-0138 - Permit ApplicationPrint Form
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Associated Building Permit#
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
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V \ Fire Sprinkler F_ Fire Alarm I— Fire Misc
1. Project Address (Not mailing address)
Floor
Suite No
-2
1125... NP�W�r�t Cly' pr•
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City WA/ State -- ZipRNI Telephone—'.
2
Tenant Name#Units
Architect/Designer's Address
F
2. Description of Work
� GhU ar�i n e rna►I: �
CityQIan)& _
OQA 7-0a 6,446114
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Use IYM�
Last RAM n First C U� Lic. No. 4 W
Engineer's Address
Engineer's E-mail Address
2W & �MXW
�y
Extg Sq Ft �—', New/Added Sq Ft �-._ Total Sq Ft j� /S
Valuation $
State —' Zip 6FvR_P(; Telephone I4 z" a
F- New r r\ Add Alter F_ Demo
1 /#�riess
Check Appropriate Box for Applicant/Notification
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3. Owner's Name
Last �� WI II�VI'I V ,First(-,
I_
Owner's Address
Owner's E-mail Address
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City WA/ State -- ZipRNI Telephone—'.
r 4. Architect/Designer's Name Last It ll First Gh� Lic No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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CityQIan)& _
State Zip Telephone I!{-
F_ 5. Engineer's_ Name
Last RAM n First C U� Lic. No. 4 W
Engineer's Address
Engineer's E-mail Address
2W & �MXW
AN(, - Fa cMu r�,n�II eJrn
Cityoya e"
State —' Zip 6FvR_P(; Telephone I4 z" a
F_ 6. Contractor's Name Last v0 lG MF, irst �— — Lic No. 234V Class
s
Contractor's Address
Contractor's E-mail Address
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sgnnH&r. 5 1aufmd- tq
City IVrar VR /
State C�— Zip Fv� �5 Telephone f 5-424-3all
OFFICE USE ONLY
TYPE OF CONSTRUCTION
PERMIT NO. _r -L i O 1b
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $