HomeMy WebLinkAboutF2021-0261 - Permit Applicationz oz6I
Worksheet for Fire Permit Application o�EW�Qa
Print Form City of Newport Beach - Building Division s
Please print 3 copies " os
Associated Building Permit # X2�Z� _ 'i Fire Sprinkler [ Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenani Name <� l' _ S�GI� Q # Units �!!
2. Description of Work
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Owner's E-mail Address
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use
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Extg Sq Ft New/Added Sq Ft Total Sq Ft
Valuation $
FP New F_ Add [I Alter Demo
#Stories �7
Check Appropriate Box for Applicant/Notification
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3. Owner's Name Last
First [—
Owner's Address
Owner's E-mail Address
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State �—
Zip I----- Telephone--
F_ 4. Arch itecVDesigner's Name
Last
First --- ! Lic. No. F-- - -
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �—.—
Zip F ----- Telephone[ -
6. Engineer's Name Last
First F—_--- Lic No.
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Engineer's Address
Engineer's E-mail Address
City
State f
Zip I — Telephone
F_6. Contractor's Name Last �5� First y l� � —Lic. No. y'�J ' lass `0� 6_�'
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Contractor's Address
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Contractor's E-mail Address
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Zip C2.��1 Telephone 'IILi_ _OC55
OFFICE USE ONLY
PERMIT NO, � —
TYPE OF CONSTRUCTION
PLAN CHECK NO. 19 SQ
OCCUPANCY- GROUP
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�� C PLAN CHECK FEE $