HomeMy WebLinkAboutF2021-0484 - Permit ApplicationWorksheet for Fire Permit Application ®r.,,wvwpiv,�City of Newport Beach - Building DivisionPlease print 3 copies�%(1Q�
Associated Building Permit # IX Fire Sprinkler r1 ire Alarm r i Fire Misc
6a) 75
1. Project Address (Not mailing address)
Floor Suite No
Owner's Address
Owner's E-mail Address
F_7
Tenant Name�/.�,��1
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2. Description of Work
City State
Zip Telephoned—
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Use
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Extg Sq Ft
New/Added Sq Ft Total Sq Ft
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Valuation $ 00J c=
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New
F Add FAlter F7 Demo
# Stories
Check Appropriate Box for Applicant/Notification
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[I 3. Owner's Name Last
i First.
Owner's Address
Owner's E-mail Address
City ------.. _II State
I777 Zip �. Telephone[-- j
4. Architect/Designer's Name Last �- First F— Lic. No, �-
Architect/Designees Address
Architect/Designer's E-mail Address
City State
Zip Telephoned—
[ 5. Engineer's Name Last First
g �`-5-- Lic. No.
Engineer's Address
Engineer's E-mail Address
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-
City �12A UL�r -- State
I (� Zip -7 �6 Telephone 5/- 1153-q)'79
F-6. Contractor's Name Last f
-First Lic No. ?.3Class rB
Contractor's Address
Contractor's E-mail Address
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City //��$__----(
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OFFICE USE ONLY
PERMIT NO. �zd2 ! h,�,, 9,L44
TYPE OF CONSTRUCTION
PLAN CHECK NO, Z�UI`Jf�P2 L
OCCUPANCYGROUP
W`L`�� H3
n'' �PLAN CHECK FEE $