HomeMy WebLinkAboutF2021-0435 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Fire Sprinkler F_ Fire Alarm r` Fire Misc
1. Project Address (Not mailing Floor Suite o
/address)
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0 V DV'�Vr G0OTT
Tenant Name f w PeD # Units F
Y
2. Description of Work
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Use
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334,td Y1
JPetO(,(i(-'-
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Extg Sq Ftp, New/Added Sq Ft F'. Total Sq Ft �) (�
Valuation $
F New r" Add IY' Alter r• Demo
# StoriesJ
Check Appropriate Box for Applicant/Notification
F[ 3. Owner's Name Last Iry P°/1. First
Owner's Address U Owner's E-mail Address
WON= Mb I Pa �Yxob MVfA�_6WPyPyJ- 601,
City (� State I U Zip I r Q) I Telephone
4. Architect/Designer's Name Last I�� n First Lic. No. 4z 9,
Architect/Dessigner'stsAddrrepss,/�� Architect/Designer's E-mail Address
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City State �Zip Telephone 'ty�'O-Q_LJ
1( 5. Engineer's Name Last ��' First m 11 Lic No. 3 t
Engineer's Address Engineer's E-mail Address
City Stater I��V��/7�—�/���,,� ,1
I � Zip I�. Telephone 1 �W3 02A
F- 6. Contractor's Name Last
dao [_'�r
` / First Lic No. ' 0 Class I
Contractor's Address (�Jp IW I v Contractor's E-mail Address �
City State Zip I �� Telephone lI 3
OFFICE USE ONLY 1 I n (C¢=; , �� PERMIT NO. a r
TYPE OF CONSTRUCTION rn PLAN CHECK NO.
PLAN CHECK FEE $
OCCUPANCY -GROUP Y.��