HomeMy WebLinkAboutF2022-0160 - Permit ApplicationWorksheet for Fire Permit Application 9-P.-R,City of Newport Beach - Building Division'n Please print 3 copies ��'
Associated Building Permit # �— —I F/I Fire Sprinkler r; Fire Alarm F1i Fire MiscWWW
1. Project Address (Not mailing address)
Tenant Name
2. Description of Work
Extg Sq Ft � New/Added Sq R J Total Sq Ft _J�
El New FJ Add [ Alter F_ Demo
unecK Appropriate laox for Applicant/Notification
Floor Suite No
C- �I
# Units
Valuation $
# Stories I
❑3.Owner's Name Last
, First—,
Owner's Address
Owner's E-mail Address
City 1pV i� �� State ��4. Zip—' Telephone
--— -- --
4. Architect/Designer's Name
Last I — L _ First � L Lic. No. S5 q�_j
Architect/Designer's Address
Architect/Designer's E-mail Address
M772. 1k�,-rp S V
City wel Ct (-
State G/� J Zip T ZGS r Telephone F43�—Oi4ju1
5. Engineer's Name Last
_ First F-7—, Lic. No.
Engineer's Address
Engineer's E-mail Address
i
City �—
_— State—, Zip -, Telephone—
Last .0
�6. Contractor's Name f ((
—i v[ First I Lic. No. 4 f Z5 Class
Contractor's Address
Contractor's E-mail Address
_ }rlJ f <,v—
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City
State �� -- _ Zip 1� '_. Telephone Cll-03er� t
OFFICE USE ONLY
PERMIT NO. IA,- `d
TYPE OF CONSTRUCTION
PLAN CHECK NO. NO"" "t4'
OCCUPANCY - GROUP
'vd riOU2.4 y74f %o PLAN CHECK FEE $