HomeMy WebLinkAboutF2021-0579 - Permit ApplicationWorksheet for Fire Permit Application "`°"
City of Newport Beach -Building Divisions �S-�j D
Associated Building Permit# F Fire Sprinkler . LX.Fue Alarm F. Fne.Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Named 'moo ��:, ^�acr �o '*Units e
2. Description of Work l 5,
Use
(j Valuation$
Extg Sq Ft ' NewlAddetl Sq Ft F Total Sq Ft �u—
4Stories
r-�: New 1— Add Alter j-' Demo
Check Appropriate Box for Applicant/Notification
I-i3.Owner's Name Last
I First��
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Owner's Address
Owner's E-mail Address
Citye
State
Zlpe- Telephone'—
174. Architect/Designer s Name Last First Lic No. —
ArchitecUDesignedsAddress+
Architect/Destgner'sE-mail Address
City _
State '�—'.
.Zip Telephoned
j-5.Engineer's Name Last
jFirstLic.No.�l
Engineer's Address
Engineer's E-mail Address
City.
state
"Zip �. Telephone
X6. Contractor's Name Last r7
� Kam'
First � ��- Lic. No. (��L� �j, Class C • kt),
Contractors Address
Contractor's E-mail Address
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State ��
Zip Tel `-T,(,{
OFFICE USE ONLY
PERMIT NO. F-202,1 0 57 q
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
�P07_�o _PLAN CHECK FEE $ Z18 ,7 5