HomeMy WebLinkAboutF2022-0533 - Permit ApplicationPrint Form
Worksheet for Fire Permit Application
City Newport Beach Building Division
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Associated Building Permit #
—XG2V 'Z Z—l�_? (�� ❑ Fire Sprinkler Fire Alarm
❑ Fire Misc
1. Project Address (Not mailing address)
Floor
Suite No
U
Kit
Tenant Name � ��� L9-r-,
# Units
t
2. Description of Work
�`�S � �
Use
2 LS?W V L,, ` T �?
Extg Sq Ft New/Added Sq FtF I
7� Total Sq Ft
❑ New ❑ Add Q Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
Valuation $ 2-1
# St ties
l4
❑ 3.Owner's Name Last C_- C►G� �_ First
Owner's Address
Owner's E-mail Address
I
City State
L_l Zip Telephone
4. Arch itect/Designer's Name Last
First Lic. No, i
Architect/Designer's Address
Architect/Designer's E-mail Address
I
I F_
City State
p p �� Zi Telephone
5. Engineer's Name Last — _
_ _ j First _ Lic. No.
Engineer's Address
Engineer's E-mail Address
------------
i
City i State
i
Zip Telephone
--
6. Contractor's Name Last 'mot✓ First Lic. No. �2_`)` �S Class
Contractor's Address
Contractor's E-mail Address
City �j tfi/ State
n!� Zip Telephone j 3 'i`
\__-- -- -- 9 `r �-- ---
OFFICE USE ONLY
PERMIT NO.-nZ2- !yam
TYPE OF CONSTRUCTION
�ii��'' leion PLAN CHECK NO. '?c2"p4 • 0*
OCCUPANCY - GROUP
�'�Zp2,2 0 l PLAN CHECK FEE $