HomeMy WebLinkAboutF2023-0011 - Permit ApplicationWorkeheet'for Fire Permit Application
Print Form, City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # IFire Sprinkler ❑ Fire Alarm ❑ Fire Misc
f. Project Address (Not mailing address)
Tenant Name �MCCLt-lk ,
2. Description of Work
Extg Sq Ft New/Added Sq Ft F:::� Total Sq Ft
❑ New ❑ Add KAlter ❑ Demo
Check Appropriate Box for Applicant/Notification
U__
nFlo�or Suite No
LET
# Units
Use I_--I-I
Valuation $
# Stories" 1771
❑ 3. Owner's Name
Last I �j ♦ (� �Cu Ttyc, First
Owner's Address
Owner's E-mail Address
t-7 LEA 5 CUl1e
pcJe
City ���(^t2
State PW71 Zip ; TelephoneE
❑ 4. Architect/Des!gner's
Name Last by First TOM Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
40('r, :. c-,, P�,\ � r� Tc.+�hredes� Jac;z�,�, Ncl-
City�cti� a
State Zip c('z �j' ^( Telephone
❑ 5. Engineer's Name
Last First Lic.No.�
Engineer's Address
Engineer's E-mail Address
i
City
I
I State Zip Telephoned
❑6.ContractoesName
Last ��e\ � I First FR1 Lic. No. N79 Class Oto
Contractor's Address
Contractor's E-mail Address
(1
(.o_ Nk,, -kbQ k m) ao
City Lk_ VcQ1 State ® Zip q Zgp7 Telephone
OFFICE USE ONLY
�3 ! ( PERMIT NO.
TYPE OF CONSTRUCTION �2iA�� PLAN CHECK NO.
OCCUPANCY - GROUP
„ L,` I PLAN CHECK FEE $ �--