HomeMy WebLinkAboutF2023-0139 - Permit Applicationplease print 3 copies rri 2
1
Associated Building Permit #
WorkSheet for Fire Permit Application U,65'�_Mgl
') //��7/vy�City of Newport Beach - Building Divisiono (� 3 61-1
v: Fire Sprinkler ❑ Fire Alar►n ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
F
20 l
135
Tenant Name I �c(�;se<i # Units I
L_
2. Description of Work
Use
��T • 0 4= �l 11
Valuation$
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Extg Sq Ft °L J New/Added Sq Ft ® Total Sq Ft ERE T7
# Stories (y
❑ New ❑Add Alter ❑Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owners Name Last
First
Owners Address
Owner's E-mail Address
City State F_7
Zip E-7-7 Telephoned
❑ 4. ArchitectlDesigner's Name Last
First Lic. No.
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
City State
Zip Telephoned
❑ 5. Engineer's Name Last First Lic. No.
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephoned
❑5.Contractor'sName Last E 5� First Lic. No. Class
Mdctwco Fie Prs rc.
Contractor's Address
Contractors E-mail Address
tysr c5. c + 67,
5ea4prm.ce
City State C-r7-
Zip Telephone6L
OFFICE USE ONLY
PERMIT NO. Z�j-O
497�3'
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $