HomeMy WebLinkAboutF2023-0184 - Permit ApplicationPrint Form °
Worksheet for Fire Permit Application �`"r
City of Newport Beach - Building Division
Please print 3 copies +�'oa�..
Associated Building Permit #
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1. Project Address (Not mailing address) Floor Suite No
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Tenant Name C)W_Q bqx V # Units
2. Description of Work
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Valuation $ �q 152q •iq�
Extg Sq Ft F New/Added Sq Ft �— Total Sq Ft Gj1 gj
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Check Appropriate Box for Applicant/Notification
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(- 3.Owner's Name
Last First
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Owner's Address
Owner's E-mail Address
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State F— Zip F— TelephoneF—
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 F Telephoned-
r 5. Engineer's Name
Last �— First F— Lic No. F—
Engineer's Address
Engineer's E-mail Address
City
State F— Zip F— Telephonel—
F 6. Contractor's Name Last ra�1�� First ,kA gk�1_6 Lic. No. 2,q j Class l ul
Contractor's Addresss,t`
Contractor's E-mail Address'
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State F-57 Zip `j 1-1,6}o Telephone Ct�()S j L,z
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OFFICE USE ONLY
PERMIT NO. +o�UJl�P
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PfZ- 76R ,3 — bo Ll i PLAN CHECK FEE $
15