HomeMy WebLinkAboutF2021-0529 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies .Q S ��j - ZZZ \
Associated Building Permit # 2�_7 fi ire S[ [I ; prinkler Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name # Units---
2. Description of Work
Use
Extg Sq Ft 1 New/Added Sq Ft _I Total Sq Ft—�I
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Valuation $ SO�
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j New Add [I Alter [Demo
# Stories
Check Appropriate Box for Applicant/Notification
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3. Owner's Name LastI First
Owner's Address Owner's E-mail Address
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c City i'� „ a,�/State C�..�- ZIP Telephone —.-_-...--..
4. Architect/Designer's Name Last[ First Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
City State F7 Zip F_' Telephoner
h 5. Engineer's Name Last First F77� Lic. No.i
Engineer's Address Engineer's E-mail Address LLL
City L State F Zip F77777 Telephone
h 6. Contractor's Name Lest ► ntfl- � M e 7j First (ry�pvy�� tJ Lic. No. q,-S _( -class
Contractor's Address /" "• Contractor's E-mail Address
City -_� State Zip L)Jl.(ko Telephone
OFFICE USE ONLY � .�\ C) %RUERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO
OCCUPANCY - GROUP PLAN CHECK FEE $