HomeMy WebLinkAboutF2021-0097 - Permit ApplicationWorksheet for Fire Permit Application
Please print 3 copies
City of Newport Beach - Building Division , - 0017
Associated Building Permit # Fire Sprinkler (' Fire Alarm r; Fire Misc
1. Project Address (Not mailing address)
Floor
Suite No
2115 I CQ�S- $�h� , IN2VJ�Af'G(G�►.
Tenant Name Iy S o
#Units
2. Description of Work
Use..fUl
- - e �A -
EMg Sq Ft �j � New/Added Sq Ft' . ��- I Total Sq Ft I
''� I�I
Valuation $
[7New j-, Add Alter r7Demo
#Stories
Check Appropriate Box for Applicant/Notification
it r wner's Name Last �7tj 0 2-10) P61 U, �I First
Owner's Addre s Owner's E-mail Address
r*Af i V� T17I i
�; �
city State 1 Zip �gT,elephone) U(ai�/ • -t7 �j� %
't '. ArchitecUDesigner's Name Last l� i First �I' A I—r I .Lic No. Q l
Architect/Designer's Address hitect/Desi ner's E=mail Address i
YS Y_IV1
`City State /I .Lt ZipJ� Telephonej���
Engineer's Name Last First r Lic. No, V t�
Engineer's Address Engineer's E-mail Address
city �— - ,State Zip-- ; Telephone--
6 Contractor's Nardi' , , Lastn I First s Lic. No. lass I
1 "
Contractor's Address �sVt 1 YG l aJ 1v�' Contractor's
Imo_ ' ,Ayoo _CQ ,'o�►i�[.ela��i-°--� u
City State Zip r� 1 Telephoned )X �(� ( D 61 2 -2 -
OFFICE USE ONLY 2020 (Y3= I /� PERMIT NO.
TYPE OF CONSTRUCTION " V PLAN CHECK NO. f
OCCUPANCY-GROUP�� f �'� PLAN CHECK FEE $