HomeMy WebLinkAboutF2022-0175 - Permit ApplicationWorksheet for Fire Permit Application "` "r
Print Form City of Newport Beach - Building Division } oil � � « V g
Please print 3 copies „oa
Associated Building Permit# Z( Z1-?=3cL� i ❑ Fire Sprinkler rp Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
Tenant Name111
2. Description of Work
M p_C� r1 C� '2 ScY�bPS
Extg Sq Ft �I New/Added Sq Ft 7-7-7 Total Sq Ft
New ❑ Add ❑gDAlter ❑ Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
R� FREI
# Units
Use
Valuation $ F 16, 2R
# Stories
❑ 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City i State
Zip 1 Telephoned
❑ 4. Architect/Designer's Name Last
First Lic. No.
Architect/Designer'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
6. Contractor's Name Last ��\} ���
t
First [ Lic. No. �L(�i(S Class
Contractor's Address
Contractors E-mail Address
-
City y� �lCr State
Fk7 Zip 77F Telephone qT l 3DS711pc
OFFICE USE ONLY I PERMIT NO. f 142a- 0
TYPE OF CONSTRUCTION
6 PLAN CHECK NO. 0 120q � ZO
OCCUPANCY - GROUP
/�I •� PLAN CHECK FEE $