HomeMy WebLinkAboutF2022-0061 - Permit ApplicationWorksheet for Fire Permit Application
Print Form
Please print 3 , City of Newport Beach -Building Division
copies �"
Associated Building Permit# [ Fire Sprinkler [Fire Alarm [ Fire Misc
(9
1. Project Addre s (Not mailing address), Floor Suite No
Tenant Name}� # Units
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2. Description of Work I
Use
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Extg Sq Ft �� New/Added Sq Ft � Total Sq Ft Valuation
VQ L � 1L
# Stories
[ New [7Add [Alter [ Demo -- J
Check Appropriate Box for Applicant/Notification
3.Owner's Name Last �—
First
J
Owner's Address
Owner's E-mail Address
City_
State Zip �i Telephone J
4. ArchitectlDesigner's Name Last
— First Lic. No.
Architect/Designees Address
Architect/Designees E-mail Address
City �—
State Zip Telephone—
[ 5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State Zip �, Telephone
I . L.
6. Contractor's Name Last -�Fi
r� -c—!! Lic. No. 77oiCllt5Class C LIQ
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Contractor's Address
Contractor's E-mail Address
a
C-01M
CityWt
� 11I Y) Be�,V1aY�
State Zip 245 Telephone
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OFFICE USE ONLYPERMIT
1{ NO. A
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
PLAN CHECK NO.
�� PLAN CHECK FEE $