HomeMy WebLinkAboutF2022-0543 - Permit ApplicationPrint Form
Please print 3 copies
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Associated Building Permit#
1. Project Address (Not mailing address)
Tenant Name
2. Description of Work
ire Sprinkler ❑ Fire Alarm
Extg Sq Ft New/Added Sq Ft j Total Sq Ft �I
❑ New ❑ Add ter ❑ Demo
UneCK Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last First
❑i Fire Misc
Floor Suite No
# Units i
Use
Valuation $
# Stories F
Owner's Address Owner's E-mail Address
r
City C� P9e�t I State UEF Zip 2 Telephoned
❑ 4. Architect/Designer's Name Last First Lic. No.
ArchitectlDesigner's Address Architect/Designer's E-mail Address
city 1 State Zip Telephone / n
❑ 5. Engineer's Name Last
Address
City i State
First—i Lic. No.
Engineer's E-mail Address
-- - 1L`
C Zip F Telephone I
I
❑ 6. Contractor's Name Last First ��� Lic. No. � ((74 Class
Contractor's Address Contractor's E-mail Address
City n �_� /� State t Zip G'i�p>170 Telephone G� �c� 7,_�js / 3
u�
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
1/ l ��f ��
4- ,t, 1-Jo-, ?/4 O i/
PERMIT NO. F.2022. - 6>9443
PLAN CHECK NO. _Ec-2022,-2.(c
PLAN CHECK FEE $