HomeMy WebLinkAboutF2023-0225 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # - - X Fire Sprinkler i— Fire Alarm r; Fire Misc
1. Project Address (Not mailing address)
Tenant Name��
2. Description of Work
A-dd 9 41O W C6h CM IPA( un,&i C21 a.nu . Chc d
Extg Sq Ft New/Added Sq Ft Total Sq Ft
(-' New F_ Add r Alter F_ Demo
unecK Appropriate box for Applicant/Notification
Ir—F1'/oor Suite No
#units �—
Valuation $ T � Vo
# Stories
F7 3. Owner's Name
Last I rviKc, First
Owner's Address
Owner's E-mail Address
City
State F_ Zip �— Telephoned
--
F74. Architect/Designer's Name Last First F— Lic. No.
ArchitectlDesigners Address
Architect/Designers E-mail Address
City
State Zip TelephoneF—
j— 5. Engineer's Name
Last First— Lic. No.
Engineers Address
Engineer's E-mail Address
City
State F— Zip -. Telephone
V °. Contractors Name Last L W �I U L First FD a.r%� e- I Lic. No. �SClass e
Contractors Address
Contractors E-mail Address
i9-7 7Z 1kaF.t-+Qrofz�Eia.�aA
�04.
City
State �— Zip �yZG �� Telephone rin-03ai _oty'f
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. / Co7/d�✓���%
OCCUPANCY - GROUP
PLAN CHECK FEE $