HomeMy WebLinkAboutF2021-0611 - Permit ApplicationWorksheet for Fire Permit Application o4�EW�Rm
City of Newport Beach - Building Division it
Please print 3 copies
Associated Building Permit # (JVLI Q j (-1 Fire Sprinkler [ Fire Alarm J-1 Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name ! # Units
2. Description of Work
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Extg Sci Ft New/Added S Ft n " I Valuation $ zi GJ
q (o7 tCf Total S9 Ft . 3�L�o7 --
# Stories
New edd Ater [ Demo I_r�
Check Appropriate Box for Applicant/Notification
3.Owner's Name
Last First
Owner's Address
Owner's E-mail Address -
i
City - _ --
I
--. State Zip— Telephoned
F-4. Architect/Designer's Name Last First Lic. No. F—
Architect/Designees Address
Architect/Designer's E-mail Address
City
State �— Zip C— Telephone—'
7 5. Engineer's Name
Last — _ First— Lic.No. F
Engineer's Address
Engineer's E-mail Address
City
_ State-- Zip L Telephoned
6. Contractor's Name Last
First // Lic No. ? Z47 Class'
Contractor's Address
Contractor's E-mail Address
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- -- State /� - Zip [ �7�b-. Telephone gIJ3' &-46I Z
OFFICE USE ONLY
PERMIT NO. • b(ol
TYPE OF CONSTRUCTION
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PLAN CHECK NO. ` •���
OCCUPANCY - GROUP
��� 92-11 PLAN CHECK FEE $