HomeMy WebLinkAboutF2022-0300 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit# r Fire Sprinkler [I Fire Alarm ❑ Fire Misc
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1. Project Address (Not mailing address)
Tenant Name -- .----- ------ -
2. Description of Work
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Extg Sq Ft' New/Added Sq Ft i Total Sci Ft .�
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New F_ Add [ Alter [ Demo
l.neOK Appropriate MOO Tor App icantMotlricatlon
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Floor Suite No
F77711,
#Units FZ
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Valuation $ 5 �oov
# Stories F
3.Owner's Name
Last soca qn�� 10ve �rstF—
Owner's Address
Owner's E-mail Address
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City v n 75o SQ
State %} I Zip Ct 5 � ,2Q TelephoneF
4. Architect/Designer's Name Last I Fiirrst Lic. No. �—
Architect/Designers Address
Architect/Designers E-mail Address
City I
State Zip F— Telephone
5. Engineer's Name
Last (yvr\1Gn25w First yyv OtzFw Lic. No. toj�yoy
Engineer's Address
Engineer's E-mail Address
City Lis )} {.,� State �Cq— Zip `LO 67) Telephone �2 �) L If 7c{
F6. Contractor's Name
Last (vTle2r"ti First ���e� / Lic No. ic774+ t Class �,(�
Contractors Address
Contractor's E-mail Address
City ��„- �. Gp'
State &� Zip F0O )). Telephone j�'z_71'L-14 7t/'v
OFFICE USE ONLY
PERMIT NO. ZOZZ_ 0300
TYPE OF CONSTRUCTION
_ PLAN CHECK NO. (S 23-ao'LZ
OCCUPANCY - GROUP
Q20L-L'G3' 1 PLAN CHECK FEE $