HomeMy WebLinkAboutF2021-0298 - Permit ApplicationPrint Form
Please print 3 copies 11
Associated Building Permit# r
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
r— Fire Sprinkler r- Fire Alarm F_ Fire Misc
1. Project Address (Not
mailing address) Floor Suite No es
Tenant Name llu-1 # Units �-
2. Description of Work
/! �P2fM LLB Use(7
I ��S
Valuation $
Extg Sq Ft New/Added Sq Ft Total Sq Ft F /
New (- Add r Alter r Demo # Stories
%,necK Appropriate box for Applicant/Notification
(- 3.Owner's Name Last Fi First —
Owner's Address Owner's E-mail Address
City State �— Zip �— Telephone F_
f 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_ Telephonel—
F_ 5. Engineer's Name Last 4410 First — Lic.No.�
Engineer's Address Engineer's E-mail Address
City State F_ Zip F_ Telephone
(- 6. Contractor's Name Last ,tom/ FirstFA _Kl'c'-� - - Lic No �� Class G�
Contractor's Address p A ^ / , Contractor's E-mail Address
es
City iO 611ccv State � Zip qTel hoe ?2 5/7
OFFICE USE ONLY / PERMIT NO.
TYPE OF CONSTRUCTION /� I n ✓ �I PLAN CHECK Nn i
OCCUPANCY - GROUP N `I l PLAN CHECK FEE $
V_iu uo u L�� x ���