HomeMy WebLinkAboutX2021-1723 - Permit ApplicationWorksheet for Fire Permit Application
Print Form Pp � 3' m�
City of Newport Beach - Building Division g
Please print 3 copies
Associated Building Permit # (�/� Fire Sprinkler [ Fire Alarm r Fire Misc
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1Project Address (Not mailing address)
Tenant Name
2. Description of Work
Floor Suite No
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# Units —I;
use 2 e - ----
��Valuation $
Extg Sq Ft 7I New/Added Sq Ft Total Sq Ft
# Stories
New Add �I Alter n Demo LI - 5 r p �j LLL _
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
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First
Owners Address
Owj
ner's E-mail Address
I
City
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State Zip Telephoned—
4. Architect/Designer's Name
LastAFirst ���}>t/ Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �—
-- -- -- - -
i State Zip _! Telephoned
5. Engineer's Name Last
I First F77777 Lic. No.
Engineer's Address
Engineer's E-mail Address
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city-- -
- - -- -_II
State J' Zip F Telephoned
F_ 6. Contractor's Name Last �,lcf i/ First s�yq,, Lic. No. �yt 13G1 Class j(a
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Contractor's Address
Contractor's E-mail Address
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City .J 4� L'/z'/977F _------
State ZiP ji / Telephone
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION _
PLAN CHECK NO.
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OCCUPANCY- GROUP
l PLAN CHECK FEE $