HomeMy WebLinkAboutX2021-0029 - Permit Application (3)Please print 3 copies
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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
F7 Fire Sprinkler Fire Alarm
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ri Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
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Owner's Address
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Tenant Name--,---�`��
# Units
2. Description of Work
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State �G Zip �� Telephone
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4. Architect/Designer's Name
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Extg Sq Ft �
New/Added S ��j Total S
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Valuation $_.___ 1 y I
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Alter �l Demo
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Check Appropriate Box for ApplicanVNotification
[i 3. Owner's Name
Last �� 11Vf�i First—
Owner's Address
Owner's E-mail Address
City ,l /�y�/ -��
State �G Zip �� Telephone
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4. Architect/Designer's Name
Last First
Lic, No. w
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State—, Zip ��� Telephoned
r 5. Engineer's Name
Last �_-- First+
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Lic. No, �/
F 1
Engineer's Address
Engineer's E-mail Address
City State C Zip % fiJ/; Telephonelll
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f76. Contractor's Name Last First Lic No. F
Class
Contractor's Address
Contractor's E-mail Address
city
Stater_-- Zip -�V Telephone
OFFICE USE ONLY
PERMIT No
000-A
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $