HomeMy WebLinkAboutF2023-0400 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
1. Project Address (Not mailing address)
1943
Tenant Name 1 p�S���IC1 tei
2. Description of Work
lL Fire Sprinkler r Fire Alarm r Fire Misc
V1€ Iola <e 3
EMg Sq Ft 3(— New/Added Sq Ft Total Sq Ft J� oZ y6
(— New r Add r�Alter 17 Demo
Check Appropriate Box for Applicant/Notification
U4,
Floor Suite Noz
i 94l J
# Units F
Usee!['il¢72i_
Valuation $
# Stories vI f
r 3.Owner's Name Last
First F
Owner's Address
Owner's E-mail Address
City
State Zip F— TelephoneF—
r 4. Architect/Designees Name
Last First F_ Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_ Zip [ Telephoned
r 5. Engineer's Name Last
�— First F Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip F_ Telephoned
r 6. Contractor's Name Last r�l (u � First lam- Lic No. g q 5 Class
Contractors Address
Contractor's E-mail Address
r
City / V1 d WCq y C 4 y
I /
State C4 . Zip y 576 Telephone 7 j 4 -?2cq , o(i s /t
7C
OFFICE USE ONLY
XG k Ls — �Oo( 6 PERMIT NO. Z n 3 ` qoo
TYPE OF CONSTRUCTION
�� �2TZ� vLU2- PLAN CHECK NO.
OCCUPANCY- GROUP
i 11 _ PLAN CHECK FEE $
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