HomeMy WebLinkAboutF2021-0397 - Permit ApplicationOf Work
Worksheet for Fire permit qAPiiCation
9 Division
City of Newport Beach - Buildin
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r Fire Sprirnkler
Fire Alarm
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_V A o Floor
�_� x_ r — L Suite
—No
#Units L 1
—_��er
�_. H vn q Ft New/Added Sq Ft 7777
-- ---
C New -- ---- Total Sq Ft
Add Valuation $ 7
C Alter Demo
3 — - _l Check Appropriate
Box fOrgppiicant/Notitication #Stories � 1
1 3. Owner's Name L
Owner's Last
C )Address
E
First
O------"�--t
-__
wner's
City -mail Address Gf
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( 4.ArchiteStatect0 esi— .- -' zip
gner's Name i Telephone
Architeot/Designees Last \n`
_-__----- ---� ress
First
d_
\ U� A u0 d Architect/Designer,
- - Lic. No. _
City if gneraE-MailAddress
State l.y�.,.li C'n 4,11vJ'-g
.... Zip ���S��S C S. Engineer's Name G� ; Tele�}�+ \ i
Last --.-, phone-
Engineer'sAddress
_--'-----_�-_ First
-- Engineer's Lic No.
m�
City ---__ -.
E ail Address
--------'--!_ State ---
J
_i Zip _.._
�6. Contractor's
Name Last Telephone
Contractor's
Address
First �
Lic. No.
_ ��`iOdL Class
Contractor's
City E mail Address
C _ ,6_i
- - -. State (, j�
OFFICE USE zip
Telephone
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ONLY t�
- phone
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
PERMIT NO. _
PLAN CHECK NO.
PLAN CH=