HomeMy WebLinkAboutF2022-0512 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division c s
Please print 3 copies
Associated Building Permit # n Fire Sprihkler Jl Fire Alarm n Fire Misc
7. Project Address (Not mailing address) Floor Suite No
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Tenant Name
#Units
2. Description of Work
Extg Sq Ft F-1 New/Added Sq Ft F _�, Total Sq Ft
New F Add Alter (- Demo
Check Appropriate Box for ApplicantlNotification
Use
Valuation $ R o
# Stories Fff
77
3.Ownees Name Last l Co First
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Owner's Address Owner's E-mail Address
City j7 �( State �r/pc Zip qY� 0 Telephone-
{- 4. Architect/Designer's Name Last First Lic. No.
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Architect/Designer's Address Architect/Designer's E-mail. Address
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City State �- Zip—� Telephonel
[76, Engineer's Name Last/ - First fcf< Lic. No. 1if
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Engineer's Address { Engineer's E-mail Address
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City - IJlr1Z - State W Zip I 1 Telephone_ IVII ^ 3
6.Contractor'sName Last bMF Lic. No.�Sf—' Class
Contractor's Address Contractor's E-mail Address S3 r r 3
City State Zip F— Telephoners;
OFFICE USE ONLY PERMIT NO. Zoz Z' 05 t 2
TYPE OF CONSTRUCTION PLAN CHECK NO. PCZaZ^Zqc/o
OCCUPANCY - GROUP PLAN CHECK FEE $