HomeMy WebLinkAboutF2022-0610 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # _Fire Sprinkler [-, Fire Alarm ri Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
Tenant Name
#Units
2. Description of Work
Use
1
y -1 K w
.LowUiL-7hal
Extg Sq Ft
•. Now/Added Sq Ft F Total Sq Ft F
Valuation $ 1 1 i2�jL
1
New
S//���I N IG
# Stories
(-•: Add
r Alter Demo
'1�0 _JS11t
I
Check Appropriate Box for Applicant/Notification
J6 Owner's Name Last b 64 First F__
Owner's Address Owner's E-mail Address
- -
City N 46v L,e,(I�,u State Zip G% ^ - Telephoned
F_ 4. Architect/Designer's Name Last r FirstF_
Lic. No. �—
Architect/Designers Address 34 J06 LO Architect/Designees E-mail Address
_77 city State 1 Zip �— Telephoned--
r- 5. Engineer's Name Last First �—
___-_- - Lic. No. �-
Engineer's Address Engineer's E-mail Address
City State �— ZipF TelephoneF_
) 6. Contractor's Name Last �V l �/i/( 1 i L First � � Lic. No. �1 C6ClassFc-
Contractor's Address Contractor's E-mail Address 0
Sk ta) L i��w-
city 5 &(41/1 Cap IStra,,,L� C� � Zip `1� Telephon
OFFICE USE ONLY PERMIT NO. f zy24--Ofo1 0
TYPE OF CONSTRUCTION PLAN CHECK NO. `pG�q yZ7)p�o
OCCUPANCY - GROUP 2z,omI PLAN CHECK FEE $