HomeMy WebLinkAboutX2021-2326 - Permit ApplicationWorksheet for Fire Permit Application
Please print 3 copies City of Newport Beach - Building Division 2jj
Associated Building Permit# j Fire Sprinkler f— Fire Alarm Ei Fire Misc
1. Project Address (Not mailing address) Floor Suite No
L
Tenant Name Ialj 7' 71 # Units
F
2. Description of Work
City
StateZiPF
F
!>AT -r, A
F7 4. Architect/Designer's Name
Use
First Lic. No.
Architect/Designer's Address
Valuation $
Extg Sq Ft New/Added Sq Ft
I Total Sq Ft
City
i State
New [Add Rr After F—#
4 Stories
First Lic. No.
Check Appropriate Box for Applicant/Notification
I f� 44
. ..a ..
Ej 3. Owner's Name Last L First
Owner's Address
Owners E-mail Address
City
StateZiPF
F
TelephoneF
-- -------
F7 4. Architect/Designer's Name
Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
i State
ZipF— Telephone--
F_ 5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State
Zipr Telephone F_
J6. Contractor's Name Last
First Lic. No. Class
Contractor's Address
Contractor's E-mail Address
$0A
city40 110,
State
Zipj '11-76( Telephonf 95 ,7 7
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
C LC (c�