HomeMy WebLinkAboutF2021-0293 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application o4�EW�R@
City of Newport Beach - Building Division
jy Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
1229 Nattiv�y>Qtm F o -
Tenant Name D 510ar r.v
2. Description of Work
Extg Sq Ft Fi New/Added Sq Ft [_ Total Sq Ft
r/ New F_ Add 7 Alter r Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units I
Use I `-Cs iGILC � wi
Valuation$ 5000
# Stories F
F_ 3. Owner's Name Lasttfyrj
First �—
Owner's Address
Owner's E-maiddres
City
State F_
—
Zip �— TelephoneF
r 4. Architect/Designer's Name
Last a"0C6
�"� `
First Lic. No. F
Architect/Designer's Address
ArchitectlDesigner's E-mail Address
City
State [—
Zip F_ Telephoned
r 5. Engineer's Name Last
First F__ Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State F__
Zip F_ Telephoned
[—v/ Contractor's Name Last Dv (G( First �_c_,a V1/ Lic No. Class (—ll0
Contractor's Address
Contractor's E-mail Address
1155) Y-vto-W Stcc,r;t
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huwie+r @P dices s.co>rn
City G' �(1�,`?i41 �
I
State
Zip I ZgsP 1 Telephone 14) iq 4-01S 5 1
OFFICE USE ONLY
PERMIT NO. W _I 01D
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
ryi, 0 q� PLAN CHECK FEE $
2tI-0•1-0?.o X% Im