HomeMy WebLinkAboutF2023-0339 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
1. Proiect Address (Not mailina addressl
I IIZ4/ A-uockDo /av�
Tenant Name G C&q q(ZC--'9
2. Description of Work
F_ Fire Sprinkler r Fire Alarm r Fire Misc
Extg Sq Ft DOD ? New/Added Sq Ft I Total Sq Ft / ®D) ?
F_ New F_ Add r Alter r Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
c_� # Units F
Use
Valuation $
# Stories FT
v-�
F_ 3. Owner's Name Last
First F__
Owner's Address
Owner's E-mail Address
City
State F
Zip I TelephoneF
r 4. Architect/Designer's Name
Last
First F Lic. No. r
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State F__
Zip F— Telephoned
F_ 5. Engineer's Name Last
�—
First F_ Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City �—
State F_—
Zip F_ Telephoned
'. Contractor's Name Last GA tira -Ct2N-L
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First t-jj(7 Lic No. F Class
Contractors Address
Contractor's E-mail Address
3-752) J\ez!, efw
vF S'PE 2o0
esrkN�4cVRuz@yN'S(F2(-Au Sys, t
City L N i> >'� e to
StateFc ' )^
Zip nlQvo t Telephone 5a z 3 5-3 1f6 YD
OFFICE USE ONLY
�ECi�V L� —O PERMIT NO.
TYPE OF CONSTRUCTION
xCL� _Q / PLAN CHECK NO. I (�
(�
OCCUPANCY - GROUP
PLAN CHECK FEE $