HomeMy WebLinkAboutF2022-0024 - Permit ApplicationPrint Form Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name # Units
2. Description of Work
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Extg Sq Ft — New/Added Sq Ft CJ� Total Sq Ft
f-�New r Add r Alter r Demo
Check Appropriate Box for Appiicant/Notification
Use
Valuation $ L�l f Oc
# Stories P
Information
j— 3. Ownees Name
Last `�
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First
Owner's Address
Owner's E-mail Address
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h
City )
State
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Zip IT Telephone
r 4. ArchitectlDesigner's Name Last
First F Lic. No.
Architect/Designers Address
Architect/Designer's E-mail Address
City
State
F
Zip F Telephoned
F_ 5. Engineer's Name
Last F
First Lic. No. F__
Engineer's Address
Engineer's E-mail Address
City
State
F_
Zip Telephone—
r 6. Contractor's Name Last
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q 1 ,p— First z_s' � � Lic. No. Class
Contractor's Address
Contractor's E-mail Address
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State
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Zip '%'�t0��, TelephoneT2io'ji2.984
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OFFICE USE ONLY
PERMIT NO. f ZZ 2_�-
TYPE OF CONSTRUCTION
PLAN CHECK NO. ��✓ ' �2��
OCCUPANCY- GROUP
L� PLAN CHECK FEE $