HomeMy WebLinkAboutF2022-0534 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # ❑ Fire Sprinkler i Fire Alarm ❑ Fire Misc
t. Project Address (Not mailing address)
Tenant Name
2. Description of Work
Extg Sq Ft F_77 New/Added Sq Ft �7 Total Sq Ft
❑ New ❑ Add PI Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
U
Floor Suite No
# Units �!
yYy bY, . Use
Valuation $ y�
# Stories I Y
3. Owner's Name Last U
ck First
Owner's Address
Owner's E-mail Address
City State
77 Zip � Telephonei
❑ 4. Architect/Designer's Name Last
I First I Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City State
Zip Telephoned
5. Engineer's Name Last
First I Lic. No.
Engineer's Address
—�
Engineer's E-mail Address
City State
r— I
L J' Zip � Telephoned—j
❑6. Contractor's Name Last First r p
b✓ ___ / Tt� CyAct Lic. No. DZ�i(�j� ClassPJ;
Contractor's Address
Contractor's E-mail Address C,
2 Z,� L �/\ryJiSO�'y) �'Ww1
I CCi`� °" YZ'-C 1111 C • ✓�Y`�
City �(V (� State
Zip Telephone "iS 1 UM
OFFICE USE ONLY PERMIT NO. 4 o
TYPE OF CONSTRUCTION — •��� l
PLAN CHECK NO.?e' ZG22-
OCCUPANCY - GROUP
/
ter' lf/1// PLAN CHECK FEE $