HomeMy WebLinkAboutF2022-0504 - Permit ApplicationPrint Form vvorKsneet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies Z5 _ g
32- �,1 �.FoaNs
Associated Building Permit#
x2C�l� —2 ❑ Fire Sprinkler ❑ Fire Alarm ri Fire Misc
1. Project Address (Not mailing address) Floor Suite No
19 y Go r� QLVe- CIOV,rms AeL NAACA r .fir?< STF �F-7711
Tenant Name # Units I !
2. Description of Work L —J
Y � hvw Yv S�6'�rK or !��lSfi�sY1
i
Extg Sq Ft New/Added Sq Ft I Total Sq Ft Yip O ru
—New ❑ Add [ Alter [7 Demo n 7
Check Appropriate Box for AppIicant/Notification G
Use
Valuation $ FT,
6
# Stories ' I
❑ 3.Owner's Name Last
First I I
Owner's Address
Owner's E-mail Address
City
State C Zip Telephone)
J 4. Arch itect/Designer's Name Last
First Lic. No. C
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip I Telephone
(i 5. Engineer's Name Last
First F7777,; Lic. No. CI
Engineers Address
Engineer's E-mail Address
City j
State l i Zip Telephoner_7�! i
[:6. Contractor's Name Last G{ O C i First �L19
__ _� �n _ �— Lic. N ��j ` Q Class G r;
Contractor's Address Contractor's E-mail Address
850� p4Ny
Sr Surla►
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City
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State C Zip �— Telephone i 8 1C�j Q�'1(j (}
I'
OFFICE USE ONLY
PERMIT NO. Ems/ 7)-Z— QCIf
[Pcze;
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY -GROUP
! �� r7 (n1 j7 PLAN CHECK FEE $
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