HomeMy WebLinkAboutF2021-0289 - Permit ApplicationWorksheet for Fire Permit Application (FQ%,Print Form
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit Z ( Fire Sprinkler FSCEireAlarm F- Fire Misc
1. Project Address (Not mailing address)
Z60t WeiIcI Vr?P < A3DD
Tenant Name 416e5 f
2. Description of Work l/ T
Extg Sq Ft �— New/Added Sq Ft F— Total Sq Ft YQ p v
F- New ;< Add F- Alter F_ Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units F
Use
�VValuation $ �j�dp
2
# Storie
�j -U -SP�Z
F- 3.Owner's Name Last ?4/-cY
Owner's Address
Owner's E-mail Address
City PCT QC9�� State (•aq.
,�
Zip g Telephoned
r- 4. Architect]Designer's Name Last
First �— Lic. No. F
Arch itect/Designer's Address
Architect/Designer's E-mail Address
City State F_
Zip F Telephoned
F_ 5. Engineer's Name Last
First F_ Lic. No.
Engineer's Address _
Engineer's E-mail Address
City � State F_
Zip Telephoner—
F_ 6. Contractor's Name Last ` u� 1•�,..t
First ✓�S�N Lic No. 70,�'IC1a5s
Contractor's Address
Contractor's E-mail Address
City �)"/�/Ih.,Q State `/}
Zip %2&f Telephone ys) 293-345-
OFFICE USE ONLY
PERMIT NO. l' ZO -( — D J6
TYPE OF CONSTRUCTION
PLAN CHECK NO. \56S
OCCUPANCY -GROUP PLAN CHECK FEE $
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