HomeMy WebLinkAboutF2021-0546 - Permit ApplicationWorksheet for Fire Permit Application
Zv2 i �-aS�6 City of Newport Beach- Building Division
Please print 3 copies
Associated Building Permit # — Fire Sprinkler E] Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name � � � � '� # Units �_, — _� ILL����
2. Description of Work
•-Use
17-FMOAPD - ----
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LIKE 'FOR U KZ — — -----
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Valuation $ 1 75 Q601
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Extg Sq Ft New/Added Sq Ft ��� Total Sq Ft
# Stories] ,
New C Add F-1, Alter El Demo
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last Q V T ,� 1 �. 1 First
Owner's Address Owner's E-mail Address
1
City �— —J State I Zip F Telephoned—�
❑ 4. Architect/Designer's Name Last �— First F Lic.
Architect/Designer's Address _ �rrhiteoUBesigr+e -mail Address
City State�i Zip Telephoned
F 5. Engineer's Name m
Last First
Enaineer's Address Engineer's Eail-td ress s
State Zip Telephone
6. Contractor's Name Last �� (,) I First � � M i J ! 2� �Lic. No. �r � Class
A
ONLY
Contractor's E-mail Address
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State �— Zip ;��k(Q TelephoneZP�1 7
PERMIT NO.
PLAN CHECK NO.
GROUP , � 1 , ( I/r- PLAN CHECK FEE $
2lQ 5%b •2.022`
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