HomeMy WebLinkAboutF2022-0099 - Permit ApplicationWorksheet for Fire Permit Application Please print 3 coz4��� City of Newport Beach - Building Division n yy/:�
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Associated Building Permit # -._- _ r' Fire Sprinkler X Fire Ala, m [, Fire Misc
1. Project Addrgss (Not mailing address)
Tenant Name
Floor Suite No
# Units
2. Description of Work /kr
Use
Valuation $ 104%p
EMg Sq Ft [ New/Added Sq Ft I Total Sq Ft
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Check Appropriate Box for Applicant/Notification
3. Owner's Name -
Last � �l a- t176 st
Owner's Address
Owner's E-mail Address
City )
State Zip Telephone'�j
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F cFirst
C 4. Architect/Designer's Name Last Lic No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City -
i State �� Zip Telephone
6. Engineer's Name
Last i First tG Lic.No.�—
Engineer's Address
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Engineer's E-mail Address
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State G Zip _ Telephone[To G� '
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❑6. Contractor's Name LastLlv t� lj r tF____ Lic. No. F—.Ii Class
Contractor's Address
Contractor's E-mail Address
City —_.II
State' Zip [77777 Telephoned
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
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