HomeMy WebLinkAboutF2022-0052 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print-3 copies
Associated Building Permit # F; Fire Sprinkler Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name i #Units F�
2. Description of Work
Use
Valuation $
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Extg Sq Ft � New/Added Sq Ft Total Sq Ft F
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# Stories I I Yo
F]New ❑Add ❑Alter ❑Demo
Check Appropriate Box for Applicant/Notification
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❑ 3. Owner's Name
- Last � � ���� rat�j
Owner's Address
Owner's E-mail Address
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City )
State Zip Telephone
❑ 4. Architect/Designer's
Name Last First Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
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State i Zip Telephoned
❑ 5. Engineer's Name
Last t j First IG Lic No.
Engineer's Address
Engineer's E-mail Address
City 4_b t;, �
I State F--CW—, Zip Fjjew Telephone a��i'/ k"m
❑ 6. Contractor's Name
Last �(/ �It��i Lic. No. �� Class
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Contractor's Address
Contractor's E-mail Address
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City
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State F 7 Zip �� TelephoneC�
OFFICE USE ONLY
PERMIT NO. ,F j,-z . tndd"
TYPE OF CONSTRUCTION PLAN CHECK NO. QZ(4 iC — Ull-
OCCUPANCY - GROUP
PLAN CHECK FEE $