HomeMy WebLinkAboutF2021-0312 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit#
Worksheet for Fire Permit Application
City of Newport Beach - Building Division fZo2I - 6,3 Z
Fire Sprinkler r Fire Alarm F Fire Misc
1. Project Address (Not mailing address)
TenantName ....... _._ __._.:
2. Description of Work
RAV- 2.1 a W 2—,R
ire Sy�i i�tn,s.
Extg Scl FtNew/Added Sq Ft F_ Total Sq Ft 2, �+&7
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(— New r— Add IVi Alter F_ Demo
Check Appropriate Box for Applicant/Notification
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Floor Suite No
#Units f — --I
Use
Valuation $ or 51c�
# Stories
(- 3. Owner's Name Last
First (—
Owner's Address
Owner's E-mail Address
City _
State �--.
Zip F_ Telephoner---
r— 4. Arch itect/Designer's Name
Last 1 1 ilb�/) First VCV v Lic. No. 273
1 1 O
Architect/Designer's Address
Architect/Designer's E-mail Address
City __.
State �—
Zip r---- Telephoners—
[ 5. Engineer's Name Last 6 First �UVh� Lic. No.
Engineer's Address
Engineer's E-mail Address
City �_ / i_.._
State ��
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Zip inL�. Telephone `ct- �3 b�.1. %�'2r%,
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6. Contractor's Name Last l { i11
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First �— -- Lic. No.. Class
Contractor's Address �U
Contractor's E-mail Address
City (� 1/Vt ✓1Gl/
State r—/ N
v ,
Zip r— Telephone �I 3t.v.�{ L'{v/ 4I
OFFICEV USE ONLY
PERMIT NO. lejZJP_�� (A — 015k Z
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
ZC
f PLAN CHECK FEE $