HomeMy WebLinkAboutF2021-0232 - Permit ApplicationWorksheet for Fire Permit Application
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City of Newport Beach - Building Division Io -
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Associated Building Permit # �� I �/j /i� r Fire Sprinkler 'X Fire Alarm f— Fire Misc
1. Project Address (Not mailing address) L Floor Suite No
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Tenant Name # Units —
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2. Description of Work
ins-Fa,LL -F;4e--ffloim 'Spr,n0er YVlonif&ring use e� ���
EMg Sq Ft ' u tCJ New/Added Sq Ft Total Sq Ft (� Valuation $ /a =
New ' �F_ Add �Alter F Demo #Stories r
Check Appropriate Box for Applicant/Notification
r; 3.Owner's Name Last
er
Firstic
Owner's Address
Owners E-mail Address
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City lVer;� ;ReOeack
State GA-..
ZIP `Z��xpt.�Telephone F -_757 L
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4. Architect/Designer's Name
Last First I-------' Lic No. (----
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �--
Zip F-- Telephoner----
F7 S. Engineer's Name Last
NA
First F— --
Lic. No. �-
Engineer's Address
Engineer's E-mail Address
City _. _... _.
State r_.
ZiP�_-- TelePhone[_.----.-_ _.
6. Contractor's Name Last First � �Lic. No. FqS oClass CI o
Contractor's Address 11- �/
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Contractor's E-mail Address"
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State �f+-
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Zip 1d C�. Telephone 04
OFFICE USE ONLY
PERMIT NO. �ZdZ�rr��� OZ�jZ
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $