HomeMy WebLinkAboutF2022-0363 - Permit ApplicationWorksheet for Fire Permit Application
Pint Form.,
City of Newport Beach - Building Division _ r
Please print 3 copies WG � C. „r
Associated Building Permit # �X LZ [ Fire Sprinkler \J� Fire Alarm [ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
to R_�T6
Tenant Name
���� x� UnitsELI
��"
2. Description of Work
�Wt'f �� _('e �1Y��� bb�s
i
Use
p
—_>�.�,�
Valuation $ E Q/ c
Extg Sq Ft � � New/Added Sq Ft Total Sq Ft cD . Z�
New � Add � Alter � Demo
# Stories
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last ( J kv �2
C I First
Owners Address
wner's E-mail Address
i
City State
Zip E-7-77 Telephoned
l7 4. Arch itect/Designer's Name Last
First � Lic. No.
Architect/Designer's Address
Architect/Designers E-mail Address
--
City State
C� Zip �! Telephoned
F_ 5. Engineer's Name Last
1 First F77-7 Lic. No.l
LL��
Engineer's Address
Engineer's E-mail Address
City State
�J Zip Telephoned
V 6. Contractor's Name Last First c. No. Z Class C1ti
--
Contractors Address
Contractor's E-mail Address
22
Gr
City �^�Cp� State
Zip F74 1 Telephone
t
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
/\I/,` + PLAN CHECK NO. v
l
OCCUPANCY - GROUP
lJ (�
PLAN CHECK FEE $ -��-