HomeMy WebLinkAboutF2023-0079 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # F_ Fire Sprinkler F: Fire Alarm F_. Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Li -- -
Tenant Name // i • # Units
2. Description of Work
--- -
e.-Use
- - [�A)_�_-- Ll 1
Sq Ft 7-
Valuation $
Extg New/Added Sq Ft F_� Total Sq Ft �i'
New F_. F—Alter Demo
# Stories
Check Appropriate Box for Applicant/Notification
3.Owner's Name Last
1�
First
Owner's Address
Owner's E-mail Address
City_�aQ._.
--- State ��_
Zip _- �.10�� Telephone
F7 4. Arch itect/Designer's Name
Last
First F Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City_--__
State
Zip Telephone d�
5. Engineer's Name Last
First— F—
Lic No. ,
Engineer's Address
Engineer's E-mail Address
City
State
Zip F Telephone
I—' 6. Contractor's Name Last
7E'
First �eI pL� Lic. NTJ/117 y Class z�—/�I
Contractor's Address
I
Contractor's E-mail Address
City
State F
Zip TelephoneF_
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
l`�$ZZ
Z�JJ PLAN CHECK NO.
OCCUPANCY - GROUP
/jam vol I PLAN CHECK FEE $