HomeMy WebLinkAboutF2021-0638 - Permit ApplicationWorksheet for Fire Permit Application o& °
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # — — Fire Sprinkler j—; Fire Alarm rI Fire Misc
1. Project Addr ss ((Not mailing address) Floor Suite No
Tenant Name ---. -- — _ - - _ - - _ # Units 1
2. Description of Work71
L
Extg S Ft New/Added S Ft Valuation $ b ®b
9 q �� q Total Sq Ft
n New [Add [ Alter Demo # Stories
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last �2� j�✓%/ First
--� - --
Owner's Address Owner's E-mail Address
f I V V�VA4- ---- - ----
City L - ; State L (;9�71 Zip i - Telephone��j
❑4.Architect/Designer'sName Last First[—, Lic.
Architect/Designer's Address Architect/Designer's E-mail Address
i
City � _ I State �— Zip �—', Telephone—
. i
(_ 5. Engineer's Name Last
First Q Lic. No.
Engineer's Address Engineer's E-mail Address
---� - -- Iox
fh( -- -- -...- - -
City _ State �— Zip Telephone 1 ( w
F' 6. Contractor's Name Last rt /llr First—'- Lic. No.
Contractors Address
City 1 y, State 7ar
OFFICE USE ONLY
TYPE OF CONSTRUCTION
Contractor's E-mail Address
Zip
PERMIT NO.
PLAN CHECK NO.
!!ff ClassF I
M
OCCUPANCY - GROUP
PLAN CHECK FEE $