HomeMy WebLinkAboutF2021-0592 - Permit ApplicationWorksheet for Fire Permit Application
F2U Z t Jity of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # jJ Fire Sprinkler ❑ Fire Alarm J Fire Misc
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1. Project Address (Not mailing address)
Floor Suite No
Owner's Address
Owner's E-mail Address
i
City
Tenant Name
�/1 I
# Units
2. Description of Work
Architect/Designer's E-mail Address
City
-... --- - — — —
State �— Zip �—, Telephone
-- ---'
Use
F_ 7_7777:7-7
Engineer's Address
Extg S Ft
9 q
New/Added S Ft
q —� Total Sq Ft
Valuation $ I I�/ ►^'-j
f
--
E6. Contractor's Name LastTc . First Lic. No. � 2?63�lass (�
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Contractor's Address
Contractor's E-mail Address
New
C Add [ Alter r Demo
# Stories j
J
Check Appropriate Box for Applicant/Notification
E713. Owner's Name Last—
First';
Owner's Address
Owner's E-mail Address
i
City
—I
State F_ J Zip �—i Telephone 111
(-' 4. Architect/Designer's Name Last
�— First �— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
-... --- - — — —
State �— Zip �—, Telephone
-- ---'
[' S. Engineer's Name Last
f
-- _FirstF77, Lic.No.I 7_
Engineer's Address
Engineer's E-mail Address
Cit _ —
State Zip Telephone—:.
--
E6. Contractor's Name LastTc . First Lic. No. � 2?63�lass (�
}
Contractor's Address
Contractor's E-mail Address
/
City Y
State - Zip
63 T Telephone
. - - --�
._7 -O bbd
OFFICE USE ONLY
TYPE OF CONSTRUCTION
PERMIT NO.
PLAN CHECK NOY
OCCUPANCY - GROUP
Ulm/ PLAN CHECK FEE $
210 °2021 x21 n 3