HomeMy WebLinkAboutF2022-0559 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit #
XG2e?iz� IQ2� F_ Fire Sprinkler F_ Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
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Tenant Name
2. Description of Work
Extg Sq Ft New/Added Sq Ft Total Sq Ft
_._--
F- New r Add \�o Alter F_ Demo
Check Appropriate Box for Applicant/Notification
ppFloor Suite No
O� ti,
# Units I \
Use
Valuation $
# Stories It,,
[- 3. Owner's Name Last First
Owner's Address
Owner's E-mail Address
City State Zip
Telephoned----
F, 4. Architect/Designer's Name Last
First F_ Lic. No.
Architect/Designers Address
Architect/Designers E-mail Address `
177
1• -
City _ State F_-
Zip
F Telephoned-
[ 5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City State Zip
F_' Telephoned
S6.Contractor's Name Last �/A p �l�
First ���y rc4 Lic. No. _72_ Class Cl 0
Contractor's Address
Contractor's E-mail Address
2LA- LaVlJ-SPA
-
City e(� - -. State �l Zip
I
��1 �'� Tetephone ��?._r,�, 1OD
OFFICE USE ONLY
PERMIT NO. �'fi0'Jr!%i brl'S�
TYPE OF CONSTRUCTION
PLAN CHECK NO. �b?� yllfo
OCCUPANCY - GROUP
PLAN CHECK FEE $