HomeMy WebLinkAboutF2021-0582 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit#
Fire Sprinkler r{ Fire Alarm r-i Fire Misc
1. Project Address (Not mailing address) Floor Suite No
/ 9 2 y N• /�or� z
Tenant Name # Units
2. Description of Work
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1 ._. .-Use -- - - -
Valuation $
Extg Sq Ft New/Added Sq Ft Total S Ft
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New [Add [ Alter Demo #Stories F
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3. Owner's Name Last _— First
Owners Address Owner's E-mail Address
City -- _ — --_—, State F-1 ZIP F-- Telephoner
4. Arch itect/Designer's Name Last First Lic No. Architect/Designees Address Architect/Designer's E-mail Address
city — — State �— Zip I 77 1 Telephoner
5. Engineer's Name Last First
Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip �!, Telephoner
F-6. Contractor's Name Last adz First s r Lic. No. p
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Contractor's Address Contractor's E-mail Address
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City j'yiOJ�✓� - State I (511— Zip %i°I L Telephone rnZ� fJ
OFFICE USE ONLY. . PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO. �� • �i�6Z ,
OCCUPANCY - GROUP 4�• / 1
PLAN CHECK FEE$"