HomeMy WebLinkAboutF2023-0212 - Permit ApplicationWorksheet for Fire Permit Application I ?`W 1
Print Form City of Newport Beach - Building Division
Please print 3 copies �<;.eaN'
Associated Building Permit #
Fire Sprinkler r Fire Alarm I— Fire Misc
1. Project Address (Not mailing address)
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Floor Suite No
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Tenant Name M C
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#Units F
2. Description of Work
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Use
Extg Sq Ft _ �S
New/Added Sq Ft �— Total Sq Ft 3_7j
Valuation $ �"'
Add
r— New r (—
Alter (— Demo
# Stories F
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name Last
First (—
Owner's Address
Owner's E-mail Address
City _
State F— Zip [_ Telephone—
r 4. Architect/Designer's Name
Last First F Lic. No.I —
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State F_ Zip F— Telephone—
r 5. Engineer's Name Last
�— First F_ Lic. No. F—
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip F_ Telephone F_
X6. Contractor's Name Last _P�� First I4; C
I�GLic. No. � Class —/ (.
Contractor's Address
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Contractor's E-mail Address 1037 " �}� 7
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City �/j� �Ov r.
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State Zip ��(�f/� Telephone 2� t%'/
OFFICE USE ONLY
PERMIT NO. ` ZaZ3 QZ I Z
PC26703. 10
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
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