HomeMy WebLinkAboutF2021-0109 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # �ire Sprinkler [Fire Alarm F_' Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name Units
2. Description of Work
First
Use
Owner's E-mail Address
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Valuation $ 500
1- !;t
Stories
Extg Sq Ft New/Added SqFt - Total Sq Ft
F
- F New Alter F-,, Demo
Check Appropriate Box for Applicant/Notification
F73. Owner's Name
Last
First
Owner's Address
Owner's E-mail Address
City
State
Zip FTelephone_
4. Architect/Designer's Name Last
First F Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State
Zip Telephone
F_ 5. Engineer's Name
Last
First Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City
State
Zip Telephone
Contractor's Name LasI
Xt
First Lic. No. E�3,qo lass
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Contractor's Address
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Contractor's E-mail Address
(OL,
City
State
..J
zip TelephoneF95)
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. o�. tot-(
OCCUPANCY- GROUP
PLAN CHECK FEE $
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