HomeMy WebLinkAboutF2023-0243 - Permit ApplicationWorksheet for Fire Permit Application urlilPrint Form City of Newport Beach - Building Division Please print 3 copies
Associated Building Permit # ire Sprinkler r Fire Alarm I- Fire Misc
1. Project Address (Not mailing address) Floor Suite No
`1�-oo #Units
Tenant Name L�v4� h-a2cp
2. Description of Work
1 Use
Valuation $ 3 i (o
Extg Sq Ft � r3 0� New/Added Sq Ft F Total Sq Ft i %; 01 r
# Stories F
I-Newr Add F-AlterF-Demo
Check Appropriate Box for Applicant/Notification
Infjorgovitmon
r 3. Owner's Name Last �-
First F--
Owner's Address
Owner's E-mail Address
City I
State
F— Zip F— Telephone
r 4. ArchitectlDesigner's Name Last
First F-- Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State
F-- Zip F-- Telephoned
F- 5. Engineer's Name Last
First �— Lic. No. F
Engineer's Address
Engineer's E-mail Address
City
State
F--- Zip F— Telephoned
D(6. Contractor's Name LastL[���,1�� First F Lic M No.Classr
Contractor's Address ` ` - y
` _-'
( Contractor's E-mail Address
City
State
�y Zip `!' �(' Telephon ( 7W- r�
OFFICE USE ONLY
PERMIT NO. EZ {--r_i - U Z -'I'S
TYPE OF CONSTRUCTION
PLAN CHECK NO.�c�5
OCCUPANCY - GROUP
() y i PLAN CHECK FEE $