HomeMy WebLinkAboutF2023-0162 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit#
Worksheet for Fire Permit Application ?EW�q>
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City of Newport Beach - Building Division 5 `�
1. Project Address (Not mailing address)
r Fire Sprinkler r Fire Alarm r Fire Misc
Tenant Name ,4,,, ....
2. Description of Work
Extg Sq Ft F_
New/Added Sq Ft F— Total Sq Ft I
F New r Add r Alter (-- Demo
laueuK mpproprlaze mox Tor Appllcant/NOtItIcation
Floor Suite No
# Units I
Use
(G,!96
Valuation $
# Stories F
F 3. Owner's Name Last
�—
FirstF
Owner's Address
Owner's E-mail Address
City I
State F—
Zip r— Telephonedr—
4. ArchitecUDesigner's Name
Last
First F— Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State �—
Zip I— Telephone—
r 5. Engineer's Name Last
/1?arG 12�, 1
First F— Lic. No. F—
Engineer's Address
Engineer's E-mail Address
i3700 A44,y k,
-,44-/�-2 _
rIyr�.�y�F�zS�S�47
City ,
State �?
Zip 9�7 (o%� Telephone
r 6. Contractor's Name Last �Yrc fry j First �— Lic. No. 73Z53 , Class
Contractor's Address
Contractor's E-mail Address
13 9oa A% -, pi-
Iitifa-�,��-c,��.s�-C. .q
City ,� y yr yl�
State
Zip Telephone
9y�:�;.
OFFICE USE ONLY
PERMIT NO. I- Z023 - 0 Intl Z
TYPE OF CONSTRUCTION —
PLAN CHECK NO. PG2(��'j o23- 2 `(
OCCUPANCY - GROUP
PLAN CHECK FEE $