HomeMy WebLinkAboutF2022-0293 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach -Building Divisio (i�2� �
Please print 3 copies
Associated Building Permit # Fire Sprinkler r Fire Alarm r; Fire Misc
1. Project Address (Not
Tenant Name
2. Description of Work
j'e I QCCA i_P 2-°l FIZ E0,1n4a4 ir, S�4w ill
Extg Sq Ft —I New/Added Sq Ft �i Total Sq Ft
r 1 New r`i Add rk,� Alter r, Demo
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name Last
Floor Suite No
i
# Units
Use
Valuation $ �Q
# Stories FF
Owner's Address 00Aer's E-mail Address
IQ -Y196 - 0 --V
City I V 1l State '. I ZiP % I Telephone[,_____�
r 4. Arch itectlDesig ner's Name Last
Architect/Designer's Address
- zar _WC -- - - _
CityI v. t U� t-t —, - i, StateFcff
First �{� U �/ Lic No.l
Architect/Designer's E-mail Address
Zip "I;�..._. Telephone.i l "U36241'.
r5.Engineer's Name Last ��m� First Lic.No.3�
Engineer's Address Engineer's E-mail Address _
i
City State u- Zip -! Telephone----'
r 6. Contractor's Name Last l l A'AI , (/ VIP First 6 f Lic. No ( Ri - Class Fj—(o
Contractor's Address �'V V 'v Contractor's E-mail Address _
City _ � ,I IIA/✓ State /'YI Zip 2 Telephone''/Itl� 33
OFFICE USE ONLY PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY- GROUP ACV
PLAN CHECK FEE $