HomeMy WebLinkAboutF2021-0248 - Permit Applicationi
c
0
Worksheet for Fire Permit Application ozEW�Re
Print Fdrm �wZ I �0 Z I y � City of Newport Beach -Building Division
Please print 3 copies I t Il. Lo N�W'�(/' f �- UA<„oa,.•>
Associated Building Permit # Fire Sprinkler r Fire Alarm r-, Fire Misc o
1. Project Address (Not mailing address)
�� ter"
Floor�e,taSuite No
'-�f 7 _ IJ ear� 6,e ^ t � -D r .
PJe wp�r E &. a,: ,
GA ' F—.F__m..
_ _
Tenant Name Si'r'aL�55 oFe C O,#Units
,
-
2. Description of Work
Lx.
Zip r--- Telephoned --
r 4. Arch itectlDesigner's Name Last
1,
1"'
ArchitectlDesigner's Address
>I-,
Architect/Designer's E-mail Address
City State
Use
F_��
5. Engineer's Name Last
Valuation
Extg Sq Ft New/Added Sq F
_.._ Total Sq Ft �-----�
Engineer's E-mail Address
�
F_ New ri Add r, Alter r—Demo
Zip r.---- Telephone----
6. Contractor's Name Last ���
�
# Stories 1
Check Appropriate Box for Applicant/Notification
3. Owner's Name Lasty
I��tv�
�� ter"
First F — --
Owner's Address
Owner's E-mail Address
ILOO T
city I rJ r,..ti State
Lx.
Zip r--- Telephoned --
r 4. Arch itectlDesigner's Name Last
First F -- Lic No. F
ArchitectlDesigner's Address
Architect/Designer's E-mail Address
City State
�--
Zip F_ Telephoner_
5. Engineer's Name Last
First—_ Lic. No.
Engineer's Address
Engineer's E-mail Address
City State
�—
Zip r.---- Telephone----
6. Contractor's Name Last ���
�
First Yln �l Lic. No.� J�Iass E- t
y_ynl
Contractor's Address 1 + '
t
4ractor's E-mail Address
��'I � L ��-Pr/ �� • �
DG F:�r�t.(�v'e E.��li� �n�aa(�,aw�
City wC-�,7. State
�/� _
Zip qL���� Telephon (q) c)9„014L)
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP I�) PLAN CHECK FEE $