HomeMy WebLinkAboutF2022-0259 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division h
Please print 3 copiesb
Associated Building Permit # Fire Sprinkler Fire Alarm [Fire Misc
1. Project Address (Not mailing address) Floor. Suite No
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Tenant Name # Units L
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2. Description of Work
Use
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Extg Sq Ft New/Added Sq Ft l Total Sq Ft I
'� Valuation $
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# Stories 57-7
rJ New ❑Add n Alter Demo
Check Appropriate Box for Applicant/Notification
3. Owner's Name
Last --j rst
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Owner's Address
Owner's E-mail Address
A/Ald VA
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City'
--J State �� Zip _ .. Z'� Ci Telephone[
4. Architect/Designer's Name Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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City State Zip I Telephone
F� 5. Engineer's Name
Last � s First t (j - Lic. No,
Engineer's Address
Engineer's E-mail Address
City L( � �� �C
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! State G Zip Telephone
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❑ 6. Contractor's Name
Last[ I t Lic. No. Class—�
Contractor's Address
Contractor's E-mail Address
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City
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State Zip Telephone
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OFFICE USE ONLY
PERMIT NO. C'ZD1.� - 0251
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $