HomeMy WebLinkAboutF2022-0162 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach -Building Division
Please print 3 copies f //� 0�/ i Ol (pop
Associated Building Permit# I Fire Sprinkler r Fire Alarm rl Fire Misc
1. Project Address (Not mailing address) Floor Suite No
_-- - 710 �475 �4 c: /Neza• iw _�'.4r� e,.., A' ca! �— I
Tenant Name # Units 1 3
I
2. Description of Work
Use % A�-ii4vlfr
%n/S /la bn aP
Extg Sq Ft New/Added Sq Ft Total Sq Ft
Valuation $ 7 pp�j, �'
Js� New 7 Add F_ Alter F,_ Demo
#Stories F
Check Appropriate Box for Applicant%Notification
F 3. Owner's Name
Last j First—
Owner's Address
Owners E-mail Address
I
CiTy
State — Zip Telephoned
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rl4.Architect/Designer'sName Last First Lic. No.
Architect/Designers Address
Architect/Designees E-mail Address
City- _--_ --_
-------_._., State Zip-., Telephoned'..
[' 5. Engineer's Name
Last First Lic No.
Engineer's Address.
Engineer's E-mail Address
City
State � Zip F— Telephoned
�6. Contractor's Name Last
. ��A First jvl I Lic. No.
�— [ 5Sf (Is Class C-!lo
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Con,trractor's Address
Contractor's E-mail Address
t.i> M ' /.
City f�St 2l,�� c
State I Zip Telephone g�q 228 - 11961
OFFICE USE ONLY
TYPE OF CONSTRUCTION
PERMIT NO.
�% /I'2 ` PLAN CHECK NCO •
OCCUPANCY - GROUP
PLAN CHECK FEE $
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