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HomeMy WebLinkAboutF2021-0244 - Permit ApplicationWorksheet for Fire Permit Application QR31 Print Form City of Newport Beach - Building Division Please print 3 copies Associated Building Permit # (— Fire Sprinkler r Fire Alarm Fu Fire Misc 1. Project Address (Not mailing address) Floor Suite No 5©n L-9 rc CL CA*_a c4 r F Tenant Name I # Units F 2. Description of Work //�� �Yc�n k 4Q rS 34 W*5 Use Extg Sq Ft New/Added Sq Ft Total Sq Ft 33 0 o Valuation 5 31700 # Stories F_New F-Add F_Alter r Demo Check Appropriate Box for Applicant/Notification F- 3. Owner's Name Last First C(n rr,, Ale Owner's Address Owner's E-mail Address City State F__ Zip F_ Telephoned i" 4. Arch itecUDesigner's Name Last First F_ Lic. No. Architect/Designer's Address Architect/Designees E-mail Address City I State F_ Zip F Telephoner_-- F_5. Engineer's Name Last � � First F_Lic. No.l_ Engineer's Address Engineer's E-mail Address City State F__ Zip f TelephoneF- 6. Contractor's Name Last / First V t�cjcS Lic No. /p�p(,� Class Contractor's Address Contractor's E-mail Address 3 -Jr4 �k,_ Ur e`r 9 s ctwxorf, Ley - city &Att State I "� Zip Telephone 7 I OFFICE USE ONLY PERMIT NO. YM J ''` TYPE OF CONSTRUCTION _ bb PLAN CHECK NO.iM6 OCCUPANCY- GROUP �S�i 1 PLAN CHECK FEE $ ,, tUq Dop✓ i� a0 Corte I Zaz