HomeMy WebLinkAboutF2021-0504 - Permit ApplicationPrint Form Worksheet for Fire Permit Application 15EW�Re
�� i� ity of Newport Beac - Building Division /
Please print 3 copies V0
5 q
Associated Building Permit # Q l !Y Fire Sprinkler F_ Fire Alarm F_ Fire Misscc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name ��� a A � � # Units
2. Description of Work
use (ARS
r J{ V���v�� irk �%lliC«
r 4. AlrchitVect/Desigo/e^r'(s4Nlame Last 1 J� MVi t�/} First Lid. No. ���( (j
Architect(Designer's Address_ Architect/Designers E-mail Address Q
T, Efl ITi,
'%iJ ^.—
Extg Sq Ft r-e�'" New/Added Sq Ft Total Sq Ft�---- � n�
w
Valuation $� 0
F_ New F_ Add Alter F_ Demo
J
Engineer's E-mail Address
/#5
Check Appropriate Box for Applicant/Notification
I nf�rwn4'�r
3. Owner's Name Last l06 � I/�`
Owner's Address
ow'ner's E-mail Address
City (I}j) �!. \" ',�j�(�/ i/1
'.. State Zip
r 4. AlrchitVect/Desigo/e^r'(s4Nlame Last 1 J� MVi t�/} First Lid. No. ���( (j
Architect(Designer's Address_ Architect/Designers E-mail Address Q
T, Efl ITi,
city Wn/! )
- State -- ZipF Telephone I(L 4s 11
(- 5. Engineer's Name Last _���� First �, �,�'� Lic. No. %rte' 7
Engineer's Address
ff %) �
Engineer's E-mail Address
City �,; 1k ,)
State, - Zip R J6�j Telephone 193
6. Contractor's Name LastVIM(
1l
'ri W (� �rpefll lvL ---�-- Lic. No. ", (%class F
0
I 4 7" YiContractor's
Contractor's Address 1�
E-mail Address
City
State -q-s--- Zip Telephonell
C ,
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
— PLAN CHECK NO.
OCCUPANCY - GROUP
C) 1-7 PLAN CHECK FEE $