HomeMy WebLinkAboutF2023-0582 - Permit ApplicationWorksheet for Fire Permit Application
Print Form
City of Newport Beach - Building DivisionPlease
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print 3 copies
Associated Building Permit # Fire Sprinkler F_ Fire Alarm
r Fire Misc 17 Iff4o J
1. Project Address (Not mailing address)
Floor Suite No
Tenant Name i 61vTA-1_ 0FF/6F
#Units Fjo
2. Description of Work h ru�� t --- � 11
itiir S Q12 (/%- 9--t6t % . _77
Use
Extg Sq Ft F_New/Added Sq Ft �— Total Sq Ft F_
Valuation $
New r Add Alter r Demo
# Stories F
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 I Telephoner—
F_ 4. Architect/Designer's Name Last First I Lic. No. I —
Architect/Designer's Address
Architect/Designer's E-mail Address
City �—
State �— Zip F— Telephoned
r 5. Engineer's Name Last
M,-6L, /V First j,/,-s Lic. No. �—
Engineer's Address
Engineer's E-mail Address
S�Su,+e V",\ Ce—L-,tt,j
City Q
State r � Zip Q k Telephone 5 _ 4153 737 7
F_ 6. Contractor's Name Last
l First Sl fitn/ — Lic. No. S929'd 3 Class 6
Contractor's Address
Contractor's E-mail Address
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li (L, 5 F'�l �L / izE f �c} �jv f PyWiGflaN. GJ�,ti
City �� ,
Q
State �— Zip / og �� / Telephone
l0 07
OFFICE USE ONLY
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P C/ w v/� • 1-1 O `{ PERMIT NO. �✓� . o SS `—
TYPE OF CONSTRUCTION
,�'d2 y, ,per PLAN CHECK NO - ?III
OCCUPANCY - GROUP
o PLAN CHECK FEE $