HomeMy WebLinkAboutF2023-0008 - Permit ApplicationWorksheet for Fire Permit Application (rj�
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City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # ( ❑ Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name mfo 1AW Gi �% �� #Units F
2. Description of Work
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Extg Sq Ft Z O � _ New/Added Sq Ft Total Sq Ft 2 S 0 l� 1
New E. Add F41ter F- Demo
Check Appropriate Box for ApplicantINotification
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Valuation $ g Q
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# Stories I
3.Owner's Name Last i First
Owner's Address Owners E-mail Address -
City State �I Zip — Telephone
4. Architect/Designer's Name Last First Lic. No.
Architect/Designers Address Architect/Designer's E-mail Address
City _ State Zip Telephone
S. Engineer's Name Last First F_ Lic No.
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Engineer's Address Engineer's E-mail Address
City State F_: Zip Telephoned
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[v b. Contractor's Name Last A D� l First L I _ Lic. No, 3 a-72 VClassclI
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£ontractors Address Contractor's E-mail Address
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City ` j �ryl� .- State I ` Zip i_ 7� Telephone i p lI
OFFICE USE ONLY PERMIT NO. `�.�D'L3—D001$
TYPE OF CONSTRUCTION V�a t PLAN CHECK NO./01170 -
002,1/
OCCUPANCY - GROUP PLAN CHECK FEE $