HomeMy WebLinkAboutF2023-0044 - Permit ApplicationWorksheet for Fire Permit Application qlw�ypCity of Newport Beach - Building Divisiona0�3 -��1,Please print 3 copies ,, \yy\// i / t- Lf�
Associated Building Permit # �. I/LSFire Sprinkler r; Fire Alarm Fire Misc
1. Project Address (Not mailing address)
10IS19 (3 �-
Tenant Name
2. Description of Work
Extg Sq Ft -I New/Added Sq Ft F Total Sq Ft
New F7 Add C- Alter F_ Demo
%,necK fappropnate lsox Tor Hppucanurvotmcation
Floor Suite No
#Units
Use f Z
Valuation $ T� poV
# Stories I Z
3. Owner's Name Last
:First 7—
Owners Address
Owner's E-mail Address
City State
Zip F-77 TelephoneF_
F_ 4. Architect/Designer's Name Last
First �— Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City State �—
Zip �— Telephoned
j- 5. Engineer's Name Last
First Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City State F—
Zip F Telephone
[- 6. Contractor's Name Last /]A 0 �3 Tv� _ First _ �( Lic. N Class
Contractors Address
-
Contractor's E-mail Address C
City �. J ( O -- State I V —
Zip _ ... TeQA v, �l �`
OFFICE USE ONLY
PERMIT NO. dr (J
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
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