HomeMy WebLinkAboutF2021-0263 - Permit ApplicationWorksheet for Fire Permit Application (F&�`°amCity of Newport Beach - Building Division
Please print 3 copies F Z o Z I^ O 'o, r
Associated Building Permit # icl — y 1,3 a (- Fire Sprinkler [X Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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/ �^ a' # Units L
Tenant Name 5hc+.rlCee.�./ l�i/�..c� ''1`'avpe�e�.✓t........._ f --- -'
2. Description of Work
UseFA _u—
•-Valuation
City
StateF_ ----- Zip (-. Telephoned-----
Extg Sq Ft '� � "� New/Added Sq Ft � y � Total Sq Ft 3,P "j
Valuation $j
Last r -- First -- ' Lic. No.
# Stories
F_New r Add JR Alter f—Demo
Architect/Designer's E-mail Address
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
FirstFm rckr4D
Owner's Address
Owner's E-mail Address
City
StateF_ ----- Zip (-. Telephoned-----
r; 4. Arch itect/Designer's Name
Last r -- First -- ' Lic. No.
r---
Architect/Designer's Address
Architect/Designer's E-mail Address
City _.
State F zip F— Telephone--_—
(- 5. Engineer's Name Last
First F_ Lic No.
F_
Engineer's Address
Engineer's E-mail Address
City _._
State F Zip F Telephoned..---_-
-.....
F_ 6. Contractor's Name Last I �/'� First -f� 11, Lic. No. 17gq q-0 ClassFr--j-0
Contractor's Address
Contractor's E-mail Address
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City k `"�%/V w -p, :wazm
State r. -(',j Zip � dZS ... Telephone . `U -17Gt 7-q q �
OFFICE USE ONLY
PERMIT NO. ✓�
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TYPE OF CONSTRUCTION
PLAN CHECK NO.
21
OCCUPANCY- GROUP
�� M, lbw PLAN CHECK FEE $