HomeMy WebLinkAboutF2022-0143 - Permit ApplicationWorksheet for Fire Permit Application oqp6t,
City of Newport Beach - Building i on
oPlease print 3 copiesf�
Associated Building Permit# ire Spri � Fire rm [-I Fire Misc
1. Project Address (Not mailing address) Floor �Suite No
L— I
Tenant Name # Units
2. Description of Work
Extg Sq Ft (,, I New/Added Sq FTotal Sq Ft Valuation $g_fyo - /, G[.G� --- --
w [ Add [ Alter [ Demo It Stories -
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last Q/p�'�j01>� First F.
Owner's Address (f Owner's E-mail Address -
�12u
City State Cl- --� Zip Telephon
_J
4. Architect/Designer's Name Last First �- Lic. No.
ArchitectlDesigner's Address Architect/Designer's E-mail Address
City State I Zip F-77 Telephone—
[ 5. Engineer's Name Last _- - - First �— ✓ . No.
Engineer's Address Engineer's E-mail Address
City State F Zip Telephone
6. Contractor's Name Last st/'ieaztd� First Lic No. Olass
Contractor's Address Contractor's E-mail Address
w��/���
city l�(��jLs State F-7o— Zip jj//ld Telephone
OFFICE USE ONLY < /��'t % PERMIT NO. ZZl
TYPE OF CONSTRUCTION D�./ Y ��� PLAN CHECK NO.
OCCUPANCY- GROUP v�e. PLAN CHECK FEE $