HomeMy WebLinkAboutF2022-0376 - Permit ApplicationPrint Form
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Associated Building Permit #
Worksheet for Fire Permit Application UCity of Newport Beach - Building Division
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j Fire Sprinkler E Fire Alarm F—l' Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
1- ZS PShFero
Tenant Name — —
# Units
2. Description of Work
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Use
J
Valuation$ Sooc,00
Extg Sq Ft �i New/Added Sq Ft Total Sq Ft II
F'y New r7 Add FI Alter I— Demo
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#Stories
Check Appropriate Box for Applicant/Notification
1- 3. Owner's Name
Last I fnWheejtYL First
Owner's Address
Owner's E-mail Address
City
State F-77 Zip E� TelephoneF71
❑ 4. Architect/Designees Name Last Apr, First Lic. No.
II71
Architect/Designees Address
Architect/Designer's E-mail Address
City
State Zip 7 Telephoned
❑ 5. Engineer's Name
Last 1 First Lic. No. �—I
III111
Engineer's Address
Engineer's E-mail Address
City
State Zip F_ Telephone)
CJ 6. Contractor's Name Last NICyr l JF_ `( First st/yv Lic. No. 144130 Class I (p
Contractor's Address
Contractor's E-mail Address
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City S;N Gkmer4e_
State CA J Zip cf2[Q7Z Telephone [ji}y 'I43-`)Goy
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. pG�iUZZ
OCCUPANCY - GROUP
PLAN CHECK FEE $
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