HomeMy WebLinkAboutF2023-0206 - Permit ApplicationWorksheet for Fire Permit Application °���`°Re
Print Form City of Newport Beach - Building Division �l
Please print 3 copies �..
Associated Building Permit # X Z� jx Fire Sprinkler F_ Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
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Tenant Name
2. Description of Work l� yto . g,
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Extg Sq Ft F— New/Added Sq Ft F— Total Sq Ft r—
F New j- Add Y, Alter F Demo
Check Appropriate Box for Applicant/Notification
Floor 7iteNo#Units
Usel,
Valuation $ $ SDD • ei
# Stories I J
F 3. Owner's Name Last
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First 7
Owner's Address
Owner's E-mail Address
City I
State F_
Zip [— Telephone—
r 4. Architect/Designer's Name
Last
First F_ Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State i
Zip F— TelephoneF—
r 5. Engineer's Name Last
First F— Lic No. �—
Engineer's Address
Engineer's E-mail Address
State �
Zip F Telephone�-
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1 &Contractor'sName Last -a,tks First AAtke Lic No. `i�O115 Class C_i�
Contractors Address
Contractor's E-mail Address
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State (`'A
Zip I Telephone q<tq) *g.-1i99-
OFFICE USE ONLY
PERMIT NO. W2'D
TYPE OF CONSTRUCTION
PLAN CHECK NO. eymp' I p(a t)� t p� n
OCCUPANCY - GROUP
PLAN CHECK FEE $