HomeMy WebLinkAboutF2023-0472 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application US.""
City of Newport Beach - Building Division
r7. Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
�—
Tenant Name
# Units F
2. Description of Work
Use
Add to Sfri-A z,
Extg Sq Ft �—
II
New/Added Sq Ft �— Total Sq Ft �—
Valuation $ 2
J/00��
r New r J,dd
F_ Alter r Demo
# Stories
uneck Appropriate Box for Applicant/Notification
F_ 3.Owner's Name
Last i
First F_
Owner's Address
Owner's E-mail Address
city
State
F_
Zip F_ TelephoneF_
F 4. Architect/Designer's Name
Last
First �— Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State
�—
Zip I — Telephone—
r 5. Engineer's Name
Last �—
First I! Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City
State
F—
Zip �— Telephone�—
I— 6. Contractor's Name Last
, � wi"i r-k i5bC&ArsC Lic No. �o0S-gx_ Class���
Contractor's Address
Contractor's E-mail Address
1& u� C- V
City
�Ijji,,
�lUj #�
F,��—siQ�«I
I `1t
State
I �'A
Zip �(�JrG Telephone 77
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OFFICE USE ONLY
PERMIT NO. 2013-047Z
TYPE OF CONSTRUCTION
PLAN CHECK NO. Pc2O23- 23V
OCCUPANCY - GROUP
PLAN CHECK FEE $