HomeMy WebLinkAboutF2021-0067 - Permit ApplicationWorksheet for Fire Permit Applicatior"'o
Please print 3 copies OO(o�
City of Newport Beach - Building Division
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Associated Building Permit # Iire Sprinkler � p r Fire Alarm n fire Misc
t. Project Address (Not mailing address)
Floor � Suite No
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Tenant Name # Units
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2. Description/of Work /' '
_j`"-�1 oGu�"t� --� � �,�/ �{�� l�-1'�°/1� H'f� Use
EMg Sq Ft e- j New/Added Sq FtI I Total Sq Ft F,i Valuation $
CI New j— Add 177, Alter r Demo # Stories L
Check Appropriate Box for App !can itification
3. Owner's Name Last First
(! First
Owner's Address Owner's E-mail Address
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city- _
State F-71 Zip �'' Telephone
A;4.Act/DescUDes ddressner's Name Last i First--
Lic. No.
Architect/DesignersAddress - ----
Architect/Designer's E-mail Address
Zip l ' e I Telephon_
❑S.Engineer's Name Last F{ti,��, j^,ltg�pyLFirst—
-- — Lic. No.
Engineer's Address Engineer's E-mail Address
cityr 4 QL State Zip
r____, Telephone
[!6. Contractor's Name Last t— w.�,�
First r---1-. Lic. No. f�V�[(�' lass
Contractor's Address Contractor's E-mail Address Gzgyy 3
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city G_�GL� rn _ _►-v �Vc�-�` z ori . nom'
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4�' ..._ _ State �— Zip( Z s� Telephone
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
PERMIT NO. 00(ol
PLAN CHECK NO. U`63 2 0
PLAN CHECK FEE $