HomeMy WebLinkAboutF2022-0314 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit #
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[ Fire Misc
1. Project Address (Not mailing address)
Floor
Suite No
Tenant Name �_/_vst
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2. Description of Work
Extg Sq Ft New/Added Sq Ft Total Sq Ft F
(I New [ Add [] Alter [ Demo
Check Appropriate Box for Applicant/Notification
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Valuation$ Zp�
M# Stories
Fj 3.Owner's Name Last Tln� { t/i/t� CO First —
Owner's Address
Owner's E-mail Address
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City ` V , State _'
ZiP F, Telephone—:
[7.4.Arch itect/Designer'sName Last -- _J First— Lic.No.�—
Architect/Designer's Address
ArchitectlDesigner's E-mail Address
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Zip F_ Telephoned
F 5. Engineer's Name Last C p
First C yr, Lic. No. �—
Engineers Address
Engineer's E-mail Address
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Zip TelephoneF_____��
6. Contractor's Name Last / First j� ( Lic. No. [��;
IL _ i Alt t _ _ Class
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Contractors Address
Contractor's E-mail Address
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ZiP 0` 2. & 5T Telephone 'j (. — -
OFFICE USE ONLY
PERMIT NO. �ZeT(,Z' c)3)y
TYPE OF CONSTRUCTION
PLAN CHECK NO. S j ( Z67
OCCUPANCY - GROUP
PLAN CHECK FEE $