HomeMy WebLinkAboutF2022-0405 - Permit ApplicationU,-
Worksheet for Fire Permit Application City of Newport Beach -Building Division
Please print 3 copies
Associated Building Permit # � wZ,I ^ 3 Gq
F_/Fire Sprinkler j� Fire Alarm r Fire Misc
Floor Suite No
1. Project Address (Not mailing address)
# Units �—
Tenant Name
2. Description of Work Use
i3►7 �ir� Sprinkler D� S,�n 5-7 S
D�si4�ei'S i4ely /V�tltioocl� + i Zti►�to
Valuation $ 7j 0S j
Extg Sq Ft �— New/Added Sq Ft/4-5 30 Total Sq Ft I j5 30 �—
# Stories I 2
Iv New F Add Alter r Demo
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name Last
First I
Owners E-mail Address
Owner's Address
City
State �— Zip F_ Telephone�—
r 4. Architect/Designer's Name Last
First F — Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City
State F_ Zip — Telephone[�
r 5. Engineer's Name Last F_—
First F— Lic. No. -----
Engineers Address Engineers E-mail Address
City
State F__ Zip [_ Telephone[�
First ��_! �, f Lic. No. sgDbq�- class L to
Cy 6. Contractor's Name Last Q�C� J
Contractor's Address
Contractor's E-mail Address
S+�l)Q✓"' K�ly, vnCtikoc�i �i6S�ryice 5lilc _Corr
Telephone 4h/'�t�%-4ZZQ(4 .34-q)
City ty ��y'1�
State L- /� Zip ! 2 � � 3
PERMIT NO. r vV
'ICE USE ONLY
glj PLAN CHECK NO. �
OF CONSTRUCTION
4NCY -GROUP f7Jp2/ _ fXGo� PLAN CHECK FEE $