HomeMy WebLinkAboutF2022-0106 - Permit ApplicationWorksheet for Fire Permit Application"dam
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City of Newport Beach -Building Division � g
Please print 3 copies jilin r7/1
Associated Building Permit # rV Fire Sprinkler ❑ FirTe IA/IaLrro r vFire+Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name nits O/Q Cj �lo��Ira� i
2. Description of Work
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�� Valuation $ o0o -J
Extg Sq Ft I I New/Added Sq Ft � Total Sq Ft �j -- q� ---
F7 New r- Add n Alter j- Demo #Stories �II
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Check Appropriate Box for Applicant/Notification
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V3. Owner's Name
Last,�� �pspj� l First
Owner's Address
Owner's E-mail Address
City
State Zip[77777 Telephone
r14. Architect/Designer's
Name Last I 1,J06,DS 777 First jJ ;A -/j,,- Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City I
State F77Zip F i Telephoned
5. Engineer's Name
Last First �I Lic. No.
-- - - - -
Engineer's Address
Engineer's E-mail Address
City
State �li Zip Telephone
F06. Contractor's Name
Last sp"/ First Lic. No. /90�Z'J ,Class
Contractor's Address
Contractor's E-mail Address
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City l P m?/ vVY4 State �! Zip G%/p�lo Telephone4ZG 33 1 z J
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OFFICE USE ONLY
TYPE OF CONSTRUCTION
Cw� y�DCCUPANCY - GROUP
-7,02� l (� B
PERMIT NO. F002U-i'-(DiO6
PLAN CHECK NO. D-` 4 �-
PLAN CHECK FEE $