HomeMy WebLinkAboutF2021-0043 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies 19 1W V1 kp' „ 1-1
Associated Building Permit# I Fire Sprinkler I Fire Alarm [-IFire
1. Project Address (Not mailing address)
Floor Suite No
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Tenant Name
# Units
11
2. Description of Work
use
I
Extg Sq Ft i New/Added Sq Ft Total Sq Ft
Valuation $ S 00 oc)
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New Add ✓ter �, Demo
# Stories
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Check Appropriate Box for Applicant[Notification
["� 3. Owner's Name Last gkpo_J� First
Owner's Address Owner's E-mail Address
City StateZipZiP �— Telephoned
F_ 4 Architec esigner' Name Last /� First I ��
Lic. No. >YGi3 G
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Architect/DiE er Address Architec esigner's -mail Address
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City s -/./ `-..�J/�6y"C State e— Zip �jZ�C: Telephone/G/q
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r! 5. Engineer's Name Last �— 1, First F—
Lic No. (__ —
Engineer's Address Engineers E-mail Address
City State Zip Telephone
6. Contractor's Name Last Y� First Lic No. /3O! class
F /
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Contractor's Address Contractor's E-mail Address
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city [_ 5,0-N (fIrIne-elk_ State �'/i. Zip TelephoneF,_4
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OFFICE USE ONLY . G C �� PERMIT NO.
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TYPE OF CONSTRUCTION >` i C y C PLAN CHECK NO.
2v2-
OCCUPANCY- GROUP W&24- (, PLAN CHECK FEE $