HomeMy WebLinkAboutF2021-0135 - Permit Application- Worksheet for Fire- Permit Application - ` US
City of Newport Beach -Building Division
Please print 3 copies FS0Z' '' O I
Associated Building Permit #
j Fire Sprinkler F_ Fire Alarm F' Fire Misc
1. Project Address (Not mailing address) Floor Suite No
(al9 JIM kdo A)OdX
Tenant Name y ��si<w• # Units
2. Description of Work
Use
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/i1,!S'T�[ /A-Y�kM1� Cit- fl iL'PCti� /�`;i�✓�lA� r7/Y. S�i%inl,�2�. $'�S.{t2�
F_ 4. Architect/Designer's Name Last First F_ Lic. No.
Valuation $ 3/500.
Extg Sq Ft New/Added Sq Ft Total Sq Ft
City
New Add rl Alter (— Demo
# Stories v
Last First Lic. No. r
Engineer's Address
Check Appropriate Box for Applicant/Notification
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(- 3. Owner's Name
Last i— ,First
Owner's Address
Owner's E-mail Address
City
State � Zip Telephoner
F_ 4. Architect/Designer's Name Last First F_ Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F Zip F Telephoned
5. Engineer's Name
Last First Lic. No. r
Engineer's Address
Engineer's E-mail Address
State F— Zip F_ Telephoned
_Citgy
f 6. Contractor's Name Last First Lic. No.9j9(/S` Class Fe j(p
Contractor's Address
Contr/a�ctoor's E-mail Ad/dress
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City I Alis" (�j j
State �/, Zip �gLrS_ & Telephone (✓�4r,) 2Z0, -1%2
OFFICE USE ONLY
X `bl_f� ERMITNO. 011-0lam'
TYPE OF CONSTRUCTION
b� llI O t/ `PLAN CHECK NO.
,
OCCUPANCY- GROUP
PLAN CHECK FEE $