HomeMy WebLinkAboutF2022-0244 - Permit ApplicationWorksheet for Fire Permit Application oaEW
City of Newport Beach - Building Division
Please print 3 copies �SR
Associated Building Permit# %�J _ 2�2 Fire Sprinkler [ Fire Alarm F-I Fire M✓iisc
1. Project Address (Not mailing address)
Floor Suite No
Tenant Name u G �
#Units
2..DDescription of Work
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Use -- --
Valuation $
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Extg Sq Ft J New/Added Sq � Ft — Total Sq Ft L
New 1R- Add + J7 Alter F_ Demo
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# tones
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Check Appropriate Box for Applicant/Notification
F- 3. Owner's Name Last j -- _! First -
Owners Address Owner's E-mail Address
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City '\) --., '';, State (` -, Zip _ c)-.._ Telephoner
-••••.,,4.1Ar�chitect/Designer'sName Last First—
First
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Architeot/Designers Address Architect/Designers E-mail Address
CityState I Zip F Telephonel—
r- 5. Engineer's Name Last First
_
Lic.No. �,...
Engineers Address Engineers E-mail Address
City State F— Zip I TelephoneF—
6. Contractor's Name Last Al / First Lic. No. �37Q� Class C-�l
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Contractors Address Contractor's E-mail Address
Zip C2_/Telephon
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/Citystate
OFFICE USE ONLY PERMIT NO.
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TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY -GROUP -� I C) J PLAN CHECK FEE
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