HomeMy WebLinkAboutF2023-0410 - Permit Application,ntForm_ Worksheet for Fire Permit Application
ase print 3 copies City of Newport Beach - Building Division
Associated Building Permit #
(- Fire Sprinkler
1. Project Address (Not mailing address)
DU A15 b(z, 6,0tJ
Tenant Name
2. Description of Work
P"
Extg Sq Ft F— New/Added Sq Ft F
F- New F Add F Alter
f- Demo
Check Appropriate Box for Applicant/Notification
tnfnrm,i;.
Total Sq Ft
Fire Alarm F— Fire Misc
FI
#Units
Use
Suite No
I b U'7/
Valuation $
# Stories
F 3. Owner's Name Last iA L �fl Owner's Address
Owner's E-mail Address
City State C Zip W6
5 � p
0 TelephoneF�
F- 4. Architect/Designer's Name Last
�—
Architect/Designer's Address First Lic. No.
Architect/Designer's E-mail Address
City I State F�
Zip Telephone
I— 5. Engineer's Name Last
First[
Engineer's Address Lic No. C/
7 l ����� b� Engineer's E-mail Address l
City IJ✓� State—�
L Zip � Telephone
r— 6. Contractor's Name Last f G I 5�5
i First �— Lic No. C1� q3
Contractor's Address ( / Class
P 1� b 6 / L [ Contractor's E-mail Address
Cityl 7 C/`� Zip
State I� I1Telephone
FTrq -7 �f - trr/
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
PERMIT NO. r ZlJ7 - (Z /G
PLAN CHECK NO. G3 "
PLAN CHECK FEE $