HomeMy WebLinkAboutF2022-0108 - Permit Application1. Print Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application o�
City of Newport Beach - Building Division �, i ` _
F) Fire Sprinkler r Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name # Units
2. Description of Work
I _As-& // - i-e
Extg Sq Ft 7 — I New/Added Sq Ft
New F_ Add F_ Alter F_ Demo
Check Appropriate Box for Applicant/Notification
Use
Valuation $
Total Sq Ft
# Stories FT
[-3.Owner's Name LastAL First
Owner's Address Owner's E-mail Address
s�s_o Wr M'1551'O✓/ Mel It I' ofqz
city I or, 0_ State FEP Zip C/i76Z Telephone 6 Z6-3Kr!"C:,&tiil
F_ 4. Architect/Designer's Name Last S, 'y �, z PCj e ✓e to e�irst F_ Lic. No. l
Architect/Designer's Address �I✓o — Architect/Designer's E-mail Address
City State Zip I Telephoned
F_ 5. Engineer's Name
Engineer's Address
City
Last
First
Engineer's E-mail Address
Lic. No. �—
State F_ Zip I-- Telephoned
j 6. Contractor's Name Last eu�l� � ��� ry fy-t-,Arst FFn a6yv Lic No. Floc,7,fer Class �'/-�
Contractor's Address Contractor's E-mail Address /�
ieT-c E UGtIl,; VA-*H 44"0s�c%aj'7�o1lrvP- ✓o-ied�an 60271
city &A &� State I Clf Zip G� Telephone 0-6 Z': I
OFFICE USE ONLY PERMIT NO. FZd22"�(�g
TYPE OF CONSTRUCTION PLAN CHECK NO. d ' -0 ZZ
OCCUPANCY - GROUP D%S�1'62G4 ZZZt oa
PLAN CHECK FEE $
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