HomeMy WebLinkAboutF2021-0236 - Permit Application,:. Worksheet for Fire Permit Application
fpFigf �� " City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # �0 U k Fire Sprinkler (— Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address)
L[/74I7 Va
Tenant Name
2. Description of Work .
Extg Sq Ft r New/Added Sq Ft Total Sq Ft �—
r—New F_ Add F- Alter (- Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units F
Use 3 l�
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Valuation $
# Stories
F_ 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City
State F_ Zip F—...... Telephone
[_ 4. Architect/Designer's Name
Last First 7 Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F Zip Telephoned.
F_ 5. Engineer's Name Last
First F Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City
State F Zip Telephone
1 6. Contractor's Name Last (/_ First r J Lic. No. d�Y�3 Class
Contractor's Address
Contractor's E-mail Address
1,125— N , Zod _
rn /U �C Fin
City _-/y�
_ State Zip a5,016 Telephone?/�.&,Z-3�L
OFFICE USE ONLY
PERMIT NO. F ZC7ZI — b Z �D
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
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