HomeMy WebLinkAboutF2021-0439 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies Uq 2)q
Associated Building Permit # 1 Fire Sprinkler ❑Fire Alarm_j Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
Last - First
Tenant Name - t� /� 'z �.... �/' i9 # Units
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2. Description of Work
City
- State Zip TelephoneDi 3
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Extg Sq Ft ,' New/Added Sq Ft ��i Total Sq Ft
Valuation $
New Add Alter Demo
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Check Appropriate Box for Applicant/Notification
fI 3. Owner's Name
Last - First
Owner's Address
Owner's E-mail Address -
i
City
- State Zip TelephoneDi 3
F_ 4. Architect/Designer's Name Last - - First j Lic No.
Architect/Designers Address Architect/Designer's E-mail Address
City
State Zip Telephone
F7 6. Engineer's Name
LastFirst 1
�Jel S _, Lic. No
Engineer's Address
Engineer's E-mail Address
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---- State 164 Zip -%2 j4 8- �. Telephone ,c�sj�-13 ,7 �.
[!6. Contractor's Name
Last i�ELLv� First � � Lic No [j ggt ' Class C y�
Contractor's Address
Contractor's E-mail Address
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(�4.�4G_ State I C — Zip _ ga21 Telephone `Ill q - ��7_•��.s�� ..
OFFICE USE ONLY
PERMIT NO. F2o2� - aK3w
TYPE OF CONSTRUCTION PLAN CHECK NO. V
OCCUPANCY - GROUP
PLAN CHECK FEE $
6745 -20731 D2,oz l - 057, 5