HomeMy WebLinkAboutF2022-0115 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # i— Fire Sprinkler [ Fire Alarm r- Fire Misc
1. Project Address (Not mailing address)
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Tenant Namer R� Nla
2. Description of Work
Extg Sq Ft F— New/Added Sq Ft Total Sci Ft
F/New F_ Add F_ Alter F Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
9 1
# Units I
Use
Valuation $ Fo s-o-o
# Stories
Information
r 3. Owner's Name Last—
M tf,-1 4 First K�
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Owner's Address
Owner's E-mail Address
1 5777
City �it)Yp/ICiip�}'-
State Zi
I lam'" p
Telephone 6�
_�_��10��'-7
F_ 4. Architect/Designees Name
Last y�o _ First �� Lic. No. [g�S2_7
Architect/Designees Address
Architect/Designer's E-mail Address
City y
4e State Zip �, Telephone
5. Engineer's Name Last
First F Lic. No. C—
Engineer's Address
Engineer's E-mail Address
City
State Zip F_ Telephoned
r 6. Contractor's Name Last
First F_ Lic No. F— ClassF—
Contractor's Address
Contractor's E-mail Address
City
State F_ Zip F_ TelephoneF_
OFFICE USE ONLY
PERMIT NO. Fzo2Z-6ii5
TYPE OF CONSTRUCTION
DyG22-Gll`� PLANCHECKNO. (�606,-ZGZZ
OCCUPANCY- GROUP
PLAN CHECK FEE $ 'ZZ Z' (O