HomeMy WebLinkAboutF2022-0510 - Permit ApplicationW.,
Print Form '
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application 5
City of Newport Beach - Building Division o q
ire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
j
AzuYeE Ave J
jI
Tenant Name Hcp r l� I # Units I
II
2. Description of Work
Use
�do��cr NEw Fxrz� SPRin+'i� SYC'�s-,�
Valuation $ F3, 7� F
Extg Sq Ft I New/Added Sq Ft zj w I Total Sq Ft
❑New ❑ Add ❑ Alter ❑ Demo
# Stories ITI
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last I fo,ggo2 First
Owner's Address
Owner's E-mail Address
City I N F; i U� p�,,� CA,
P
State CND— Zip � 2(a o Telephone 7 t'-1 3� 3 4 C3-7—L
❑ 4. Architect/Designer's Name Last
First ! Lic. No. I j
Architect/Designees Address
Architect/Designer's E-mail Address
City
State �— Zip Telephoned
5. Engineer's Name Last ( First Lic No.—�
Engineer's Address
Engineer's E-mail Address
City
i
State—; Zip Telephoned
❑6. Contractor's Name Last G U rLC-C2.�'f/ I First �.y Lic. No. l&377Koc Class !
Contractor's Address
Contractor's E-mail Address
IZ3o Vhlwo)vn S�
JCL— E2_` R47F�Dn u- L-cG�
City L t-{ bfL/y
State C� Zip �0J 6) f Telephone 5
_ 2-
OFFICE USE ONLY DLt/b1� PERMIT Noy_
TYPE OF CONSTRUCTION v— Y l PLAN CHECK
OCCUPANCY - GROUP
PLAN CHECK FE e