HomeMy WebLinkAboutF2021-0095 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # I ['-Fire Sprinkler F--! Fire Alarm rl Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name -`_ e�#Units F�_
2. Description of Work
Use
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EM S Ft
9 q--' New/Added Sq Ft �– -- Total Sq Ft I
Valuation$ E� V_
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[vi' New F_ Add f— Alter Demo
# Stories
Check Appropriate Box for Applicant/Notification
177 3. Owner's Name Last
F FirstF_
Owner's Address
ner's E-mail Address
City -.. -
I State �-,i Zip Telephoned
F_ 4. Architect/Designer's Name
Last First ----' Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �— Zip �� Telephone[—
5. Engineer's Name Last
First---
-__---- Lic No.
Engineer's Address
Engineer's E-mail Address
City State Zip Telephone` ... _.
0A. Contractor's Name Last \moi � ' r .L'
��Z� Fust i J�� S Lic No. I' 6 q1(�� Jj Class
Contractor's Address
173 S lows
Contractor's E-mail Address
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state zip r"tZ�`IIv Telephone[%Ic'I C1$;J..0`��..�._ ..
OFFICE USE ONLY
TYPE OF CONSTRUCTION
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OCCUPANCY -GROUP