HomeMy WebLinkAboutF2021-0501 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
�22aZ1-p3il'7 Z't90,-�Z I
G� `L t ^ I 1 4;0 r Fire Sprinkler F_ Fire Alarm Fire Misc
1. Project Address (Not mailing address)
INJ
Tenant Name
i
2. Description of Work
Extg Scl Ft New/Added Scl Ft �, Total Scl Ft
I! New F_ Add 1--,( Alter r/& Demo
Check Appropriate Box for Applicant/Notif!cation
Floor Suite No
# Units F�j
Use
Valuation $ ) S C t
# Stories
r 3. Owner's Name
Last �C d First > &rf
Owner's Address
Owner's E-mail Address
�4 k & S G bc_-c,
City
State �— Zip F Telephone —
4. Architect/Designer's Name Last First F Lic. No. F
ArchitecUDesigner's Address
Architect/Designees E-mail Address
City
State F Zip Telephoned,
5. Engineer's Name
Last First F_ Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip F.-- Telephone—
6. Contractor's Name Last First Class �
Lic. No. 144r,
Cin�12� . ti. ( �,
Contractor's Address
yob
Contractors E-mail Address
City t LJ g H t I lib t
State Cf� Zip Telephone 1
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $