HomeMy WebLinkAboutF2023-0261 - Permit ApplicationWorksheet for Fire Permit Application
Print Farm City of Newport Beach - Building Division
Please print 3 copies /
Associated Building Permit # V Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
3 Corpts AFe Plfiz,,q F_ /_ Z
Tenant Name I
# Units F
2. Description of Work
% 7-0 �X15frly j' /I7 �I L61eQ-�S� Use
Valuation $ 3, 600.06
Extg Sq Ft � New/Added Sq rI Ft I —Total Sri
# Stories F
j- New r Add r(/ Alter F_ Demo
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name
Last First
Owner's Address
Owner's E-mail Address
City
State F— Zip F_ Telephoned
I- 4. Architect/Designer's
Name Last First 7— Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F__ Zip F_ Telephoned
F_5. Engineer's Name
Last First 7 Lic. No. ~
r
c7
Engineer's Address
Engineer's E-mail Address
t�
City
State Zip Telephoned
r 6. Contractor's Name
Last 1,i5 First lj j /U Lic. No. 7 Li& /V class h
Contractor's Address
Contractor's E-mail Address
I q °8 ts. 1�1 C in�,u�o d � I SFPoQ & 5eC6 Clue
City j U cl-elnea
Yy State - / Zip 0I Z 7 L Telephon JUG() uGj�- ilo0ca
OFFICE USE ONLY
PCZj(J%i7j•D-1df'�_ PERMIT NO./,�c`l
TYPE OF CONSTRUCTION
PLAN CHECK NO. PC �w[/3_ ( oq
\, C�Z3. 01� `
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OCCUPANCY - GROUP
d'12'LD 23.0 20 � PLAN CHECK FEE $