HomeMy WebLinkAboutF2022-0489 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies V 21_ O f�
Associated Building Permit # ❑ Fire Sprinkler ❑ ire Alarm (—i Fire Misc
1. Project Address (Not mailing address) Floor Suite NNoo
[30 D c�---- - -- - ----- — C�
Tenant NamCYei #Units 1�71
2. Description of Work
Use ReN&.
Extg Sq Ft New/Added Sq Ft Total Sq Ft
Valuation $ �7CJ
)
❑ New Add [ Alter ❑ Demo
# Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last i First ❑������
Owner's Address
Owner's E-mail Address
City State ��
Zip[777-7j Telephone� 35o y0 j�
[714. Arch itect/Designer's Name Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
I
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City _ _ 1 State ��
Zip ❑� Telephone
Fj 5. Engineer's Name Last
First Lic. No.��
Engineer's Address
Engineer's E-mail Address
t vK w-A -- e4�(rvtee zCuL-(so we
City _ State
Zip _ Telephone �/Li/--{j�j� _ 1 6 y
❑! 6. Contractor's Name Last _ First o Lic. No. Class G j�II
CIO 832
Contractor's Address
Contractor's E-mail Address 76 a
City State ❑�
Zip ❑ Telephone
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $