HomeMy WebLinkAboutF2021-0594 - Permit ApplicationF 2o24 -051 Y
Please print 3 copies
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
? / rl — i7 _ .ems
Associated Building Permit # I_
! Fire Sprinkler
1. Project Address (Not mailing address)
Tenant Name A 2-
2. Description of Work
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C Fire Alarm
EMg Sq Ft New/Added Sq Ft �— Total Sq Ft F-11
N!, New 17 Add F_ Alter r— Demo
Check Appropriate Box for Applicant/Notification
J 3. Owner's Name
Last _---------- --.__.._-----! First
Owner's Addri:ss
City State F_
U 4. Arch itect/Designer's Name
Fire Misc
Floor Suite No
# Units F
_-
Valuation $
# Stories
Owners E-mail Address
ZAP F— Telephone :,
Last First
F�
- - _ _
Architect/Designers All --- - _---
City State �—
Lic. No.
Architect/Designees E-mail Address
ZAP �—. TelephaneF�
C 6. Engineer's Name Last _ First �!
_ Lic. No.
Engineers Address Engineers E-mail Address
City State
------------- ..---------- Zip F Telephone—
p —
C 6. Contractor's Name Last G S I First (Lic. No.
Contractor's Address - 7 -?f j class C
Contractors E-mail Address C; C0
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cityClep?cl�
State j,��,�.Zip{T `7
OFFICE USE ONLY / (i ` — 1O.(-I U 1 GI N3 PERMIT NO. _V—Z -5ZA
TYPE OF CONSTRUCTION I ci 4 PLAN CHECK NO.
OCCUPANCY - GROUP `'l LI Z w v1
L7 7A7-7,/J _ 11 I e, PLAN CHECK FEE $