HomeMy WebLinkAboutF2022-0521 - Permit ApplicationWorksheet for Fire Permit Application
Print Form .� ity of Newport Beach -Building Division
Please print 3 copies t- 26 � � � G
Associated Building Permit # F Fire Sprinkler Fire Alarm [I Fire Misc
1. Project Address (Not mailing address) �—Floor Suite No
Tenant Name / °Z 2/a- #Units
C F
I
2- Descrintion of Work --__—
Extg Sq Ft New/Added Sq Ft —� Total Sq Ft
❑ New [ Add �R Alter [_j Demo
Check Appropriate Box for Applicant/Notification
Use _ -- ---------�
Valuation $ U c✓
# Stories 57
3. Owner's Name Last — _ _ First 7
Owner's Address Owner's E-mail Address
City _ _ _ State [ Zip Telephone
4. Architect/Designer's Name Last _ _ First _ Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
F_
City State �� Zip Telephone —
5. Engineer's Name Last I�GG L �-j / _ —� First C Ar_� Lic. No.I
Engineer's Address Engineer's E-mail Address
ee
City lP'�4i State Zip Telephone7---13 7 7
f'-i 6. Contractor's Name Last i✓L� .� I FirstFS�_ Lic. No. 8'7 3 Class L
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Contractor's Address Contractor's E-mail Address
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City 14 State �� Zip 9� GTelephone ��( �- gt)7 (9
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OFFICE USE ONLY PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP PLAN CHECK FEE $