HomeMy WebLinkAboutF2022-0595 - Permit ApplicationWorksheet for Fire Permit Application oaf
City of Newport Beach - Building Division aa—O5q u
Please print 3 copies r ✓ c<;,oa„�
Associated Building Permit # Fire Sprinkler F— Fire Alarm r; Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name K Sit, #Units
2. Description of Work
Use �
Valuation $
Extg Sq Ft New/Added Sq Ft 7 —�,. Total Sq Ft �i -
New Add Alter (— Demo # Stories
Check Appropriate Box for Applicant/Notification
[- 3. Owner's Name
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Last i , First-
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Owner's Address
Owner's E-mail Address
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----- State I "r"` Zip _. �C"')_-.�' TelephoneF_—..'
F_ 4. Architect/Designer's
Name Last Firsi Lic. No. �—
Architect/Designers Address
Architect/Designer's E-mail Address
City
State F_ Zip F_ Telephone�� —
r 6. Engineer's Name
Last First Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City
State F Zip TelephoneF
r 6. Contractor's Name
Last Lic. No. IdG 1, Class
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Contractor's Address
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Contractor's E-mail Address
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city(.A - - State Zip 1+Ql Telephone
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OFFICE USE ONLY
PERMIT NO. V'Z07-Z-
TYPE OF CONSTRUCTION PLAN CHECK NO. 1vC 22� ZSgO
OCCUPANCY - GROUP
PLAN CHECK FEE $