HomeMy WebLinkAboutF2023-0020 - Permit ApplicationWorksheet for Fire Permit Application Ole",cz
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City of Newport Beach - Building Division �
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Associated Building Permit i r- Fire Sprinkler [Fire Alarm rjFireMisc
1. Project Address (Not mailing
Tenant Name
2. Description of Work
Extg Sq Ft F New/Added Sq Ft —! Total Sq Ft —I
XNew r Add F` Alter r Demo
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Floor Suite No
#Units
Use
Valuation $ /{ SUS
# Stories I—...,
3. Owner's Name Last
IFirst �—
Owner's Address
Owner's E-mail Address
City -. -.-..
State —zip
Telephone - -- -
4. Architect/Designer's Name Last
First �— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State
Zip Telephoned--!
F_ 5. Engineer's Name Last
First Lic No.
Engineers Address
Engineer's E-mail Address
City
State F—
Zip F_ Telephone
F
6. Contractor's Name Last
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First ��� , Lic. No. jjg913 Class
Contractor's Address
Contractor's E-mail Address
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City �iP/✓.rOlntJ
State CFA-
Zip _%Z&J7 5.. Telephone fo-%ai'�'-7""Z)a'3�
OFFICE USE ONLY
PERMIT NO. F21I — 0020
TYPE OF CONSTRUCTION
PLAN CHECK NOF�D�j
OCCUPANCY - GROUP
PLAN CHECK FEE $