HomeMy WebLinkAboutF2021-0163 - Permit ApplicationWorksheet-for'Fi,re-Pern it Application UQq
Print Form
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler F_ Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name I -:5MI '7W /Ler�w1��L
2. Description of Work
R(f_3idevj&z,6� S�✓Ll ✓ILC�c _ S �JS ill vt
Extg Sq Ft I New/Added Sq Ft F_ Total Sq Ft F_
F_ New F_ Add j— Alter r Demo
Check Appropriate Box for Applicant/Notification
# Units F
Use
Valuation$ Co.B,
# Stories
Information
r 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City
State F_
Zip — Telephoned
F_ 4. Architect/Designer's Name
Last
First Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F__
Zip F Telephoned
r 5. Engineer's Name Last
Ca al S 6iA,
First Lic. No.
Engineer's Address
Engineer's E-mail Address
(pLI�N _ i G7LIi0r/
5i1
Sc-+Sum 4Ce__ o,cc
City a(�JJ��
State
Zip A �6 C Telephone ''1i�_0:�4q
!�
6. Contractor's Name Last /Cr —� First Sr -f Lic. No.7 ��a3 Class /
Contractor's Address
Contractor's E-mail Address
1014() 1?�GS r/S tiVl
si�.-njiL 0(L_E �_— /1afie4�.v,��
City ^ (f
State z�
Zip qI yKG Telephone 7
OFFICE USE ONLY
PERMIT NO.�I!- 0
TYPE OF CONSTRUCTION
PLAN CHECK NO. 'dgy�f•u?A
D
OCCUPANCY - GROUP
�A
LN"
PLAN CHECK FEE $