HomeMy WebLinkAboutF2022-0596 - Permit ApplicationWorksheet for Fire Permit Application3��g GFIgn
City of Newport Beach - Building Division Please print3copies1 r1Cp
Associated Building Permit# ri Fire Sprinkler Fire Alarm (- FireMisc 1
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name 54pch 5 # Units �-
2. Description of Work
Use
Ft
Extg Scl Ft F_ New/Added Scl Ft Total Sg � I
Valuation $ /� �?U p
]� New F_ Add r Alter F-Demo
# Stories
Check Appropriate Box for Applicant/Notification
3.Owner's Name
Last First i
Owner's Address
Owner's E-mail Address
City
' State �—
Zip F Telephoned--
[ 4. Architect/Designer's Name Last
First 7 Lic. No. �—
Architect/Designer's Address
Architect/Designees E-mail Address
city
State �—
Zip F Telephoned--
F_ 5. Engineer's Name
Last
First Lic. No. F—
Engineer's Address
Engineer's E-mail Address
City
State �—
Zip Telephoned
6. Contractor's Name Last
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' First Lic No. 17e%'/% Class
Contractor's Address
Contractor's E-mail Address
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City l,N /3+�.MaG?,-.vu
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Zip __. fjfjZZz� Telephone QQy-�Cf�7g'r
OFFICE USE ONLY
PERMIT NO.tpO
TYPE OF CONSTRUCTION
PLAN CHECK NO. -gel
OCCUPANCY - GROUP
PLAN CHECK FEE $