HomeMy WebLinkAboutF2022-0118 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach -Building Division b'
Please print 3 copies � 60011% O 1' O .u.oa..•�
Associated Building Permit # �, Fire Sprinkler __J Fire Alarm (-' Fire Misc
1. Project Address (Not mailing address)
Tenant Name �fl �✓ %�- - I/l h_5 ------ (= 1k �vY/�
2. Description of Work
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N r..
Extg Sq Ft New/Added Sq FtF Total Sq Ft / y j
[I New F; Add r Alter [-I Demo
Chp_rk Annrnnriatp Rnx fnr Annlirant/Nntifirafinn
Floor SuiF77te No
---- �
# Units
Use —J
Valuation $ `
# Stories n
Informatoo
F_ 3. Owner's Name Last
First J
Owner's Address
i
Owner's E-mail Address
City � State
- -- - - -'
�i
-
---- J -- - - -
Zip Telephone:
[I 4. Architect/Designees Name Last �—
I First F77777 Lic. No.
ArchitecUDesigner's Address
Architect/Designees E-mail Address
City �- J State—li
Zip TelephoneF77777
5. Engineer's Name Last
!First Lic. No. :.
-- -
Engineer's Address
Engineer's E-mail Address
i
----------- -- -- - - - ------ ----
City State
- - --
-- -
Zip Telephone
,PR6. Contr ctor's Na a Last G ofv f 4 , J
First �/�yl/ K Lic. No. �g�� Classr7T
Contractor's Address
Contractor's E-mail Address
4eC ? A
City State
Gym -
Zip Telephone go
GIC�UJ _--_ ��� _aSs-
OFFICE USE ONLY
o qI J
PERMIT NO.
TYPE OF CONSTRUCTI N�j J PLAN CHECK NO.
OCCUPANCY- GROUP PLAN CHECK FEE $