HomeMy WebLinkAboutF2023-0421 - Permit ApplicationWorksheet for Fire Permit Application 441`�
Print Form
City of Newport Beach -Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler r- Fire Alarm F- Fire Misc (�
1. Project Address (Not mailing address) Floor Suite No
Tenant Name � V � � �- M r
# Units
2. Description of Work U '
�% • r Use
Valuation$ i�w P�
Extg Sq Ft F— New/Added Sq Ft � Total Sq Ft
# Stories
F- New F- Add Alter r Demo
Check Appropriate Box for Applicant/Notification
f- 3. Owner's Name Last �—
First F_
Owner's Address
Owner's E-mail Address
City
State
Zip �— Telephoned`
F- 4. Architect/Designer's Name Last
First F__ Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F—
Zip F_ Telephoner
F- 5. Engineer's Name Last 4/)/) cc t_,4 I
First w Lic No. F—
Engineer's Address
Engineer's E-mail Address
&Ll _ jo,
W M CC 1,4(i✓ aoI U
City i2/vjL--c-
State FC4
Zip q_� Telephone q5) _'L/.r3-73-2?
F- 6. Contractor's Name Last V_,,LLvj First s ZAN Lic No. m- TClass /
Contractor's Address
Contractor's E-mail Address
City �n L�
State I�
Zip qA_e_ Telephone -7/7-2CLl
OFFICE USE ONLY�
PERMIT NO. 1�7 WU'7
TYPE OF CONSTRUCTION
x� , 17
PLAN CHECK NO.'� 213
OCCUPANCY - GROUP
C)z / z - -
PLAN CHECK FEE $
CP 86