HomeMy WebLinkAboutF2021-0542 - Permit ApplicationZWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # - - [ Fire Sprinkler ❑ Fire Alarm F Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
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Tenant Name# Units
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2. Description of Work
Owner's E-mail Address
-Use
State
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[] 4. Architect/Designer's Name
Last
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Valuation $ _,O0 w J
Extg Sci Ft I New/Added Sci Ft �I Total Sq Ft —�
Architect/Designer's E-mail Address
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# Stories
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
CN� ��(� J First
Owner's Address
Owner's E-mail Address
City
State
Zip F Telephone
[] 4. Architect/Designer's Name
Last
FirstF Lic No. —i
Architect/Designers Address
Architect/Designer's E-mail Address
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City -
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Zip Telephone
r 5. Engineer's Name Last
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First tLic.No. I
Engineer's Address
Engineer's E-mail Address
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([ S. Contractor's Name Last -���
First S Lic. No.
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Contractor's Address
Contractor's E-mail Address
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OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.� g • `% D`LI
OCCUPANCY - GROUP
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PLAN CHECK FEE $
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