HomeMy WebLinkAboutPC2023-0026 - Permit ApplicationPrint Form
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Worksheet for Fire Permit Application Obti City of Newport Beach - Building Division �aa3 _0
Associated Building Permit #
[: Fire Sprinkler V,/FireAlarm [_'i Fire Misc
1. Project Address (Not mailing address) Floor Suite No
7 c�Ci l k s� ��x� � C_7
Tenant Name # Units I
I —
2. Description of Work
FTw�J IXJ 1 rI jk,D AM
Use
Valuation $ S�
Extg Sq Ft New/Added Sq Ft F— Total Sq Ft C
❑ New ❑s/ Add [ Alter ['i Demo
# Stories
Check Appropriate Box for Applicant/Notification
[' 3. Owner's Name Last
First
Owner's Address
Owner's E-mail A ress
7C42 mi -
a
City QState
=ne��o
Zip l T2ZQ)
❑ 4. Architect/Designer's Name Last
First F77= Lic. No.l
I
Architect/Designees Address
—
Architect/Designer's E-mail Ad s
City fate
Zip 7il elephoneF7:__
❑ 5. Engineer's Name Last First Lic. No.—
Engineer's Address
i
Engineer's E-mail Addr s
City State
Zip TelephoneE
❑6.Contractor's Name Lasti First Lic. No. ���/t15 Class t✓=flJ j
Contractor's Address
Contractor's E-mail Address
70 )J ° "�Im/ Ch ihark
j�1(1 S GOn1
City if�f ft- State
Zip Telephon wpt!
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
'2
PLAN CHECK NO. FLVZ''/
OCCUPANCY - GROUP
PLAN CHECK FEE $