HomeMy WebLinkAboutF2021-0455 - Permit ApplicationWorksheet for Fire Permit Application UVICity of Newport Beach - Building Division Please print 3 copies
Associated Building Permit # F- Fire Sprinkler Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name /1(C (Z# Units
2. Description of Work II��
Use --� ?� ---
Valuation$ 2&7- c5-1
Extg Sq Ft �— New/Added Sq Ft � Total Sq Ft �- --
New [-, Add r Alter F_ # Stories Demo -
Check Appropriate Box for Applicant/Notif!cation
[" 3. Owner's Name Last
i First F_
Owner's Address
Owner's E-mail Address
City State (
Zip I TelephoneF— ___7
(- 4. Architect/Designer's Name Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State ___j
Zip Telephoned--i
5. Engineer's Name Last
First Lic. No.
Engineer's Address
I
Engineer's E-mail Address
-
City State �—i
Zip F Telephoned I
F_6.Contractor's Name Last C S First `�/�hE Lic. No. I(?'LI Class G/J
Contractor's Address
Contractor's E-mail Address
7oi7g_Lr! t�'�Zll1J2/2
/j1r(�__ e%�1��' )� reSYS'�.
City State
-, CI '�
Zip 9 Tele h)ne 3 3� 33 r 7
OFFICE USE ONLY
PERMIT NO. FZ�ZI - O45$
TYPE OF CONSTRUCTION —
PLAN CHECK NO. 227Z - aZ I
OCCUPANCY- GROUP
PLAN CHECK FEE $