HomeMy WebLinkAboutF2023-0246 - Permit ApplicationWorKsheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
Tenant Name QaC�,L Lt
2. Description of Work
Extg Sq Ft 160 11 New/Added Sq Ft Total Sq Ft
❑ New ❑ Add g Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
ZI?� 7
# Units
Use F-77777
s
Valuation
# Stories I
❑ 3.Owner's Name Last
I First O
Owner's Address
Owner's E-mail Address
City State Zip
Telephoned
❑ 4. Architect/Designer's Name Last
11 First Lic. No.
ArchftecUDesigners Address
Architect/Designer's E-mail Address
City State Zip
0 Telephoned
❑ 5. Engineer's Name Last First Lic. No.
Engineer's Address
Engineer's E-mail Address
City" State Zip
Telephoned
/
17q,6. Contractor's Name Last 1. ryz)CL) —II
�
First [? Lic No. � I l� Class Ih
Contractors Address
�J
Contractors E-mail Address
AV M
sela oco PCo C-oM
City 14A a6kb(A State FT671 Zip
Telephone
OFFICEUSEONLY X��
PERMIT NO. UZ)L)
0
o
TYPE OF CONSTRUCTION
PLAN CHECK NO Lam' LZ1/
OCCUPANCY - GROUP N (w0✓y ,
PLAN CHECK FEE $