HomeMy WebLinkAboutF2022-0509 - Permit Application (2)Worksheet for Fire Permit Application t
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Buildin
g Permit#�2U�i � �27 �J %.FireSprinkler r FireAlarm r Fire Misc:
1. Project Address (Not mailing address)
Floor Suite No
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F F_
Name I
# Units F
Tenant
2.11Description of Work
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Use
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11ea d S
Extg Sq Ft �
NewlAdded Sq Ft F_ Total Sq Ft
Valuation $ FD S OD
# Stories
New r Add r-
Aker F_Demo
Check Appropriate Box for Applicant/Notification
f- 3. Owner's Name
Last
First I
Owner's Address
Owner's E-mail Address
City
State F_
Zip
F Telephoned
r 4. ArchitectiDesigner's Name Last
First Lic. No. F
Architect/DesignersAddress
Architect/Designers E-mail Address
City
State F_
Zip
F— Telephoned
F_ S. Engineer's Name
Last
FirstF Lic. No.
Engineers Address
Engineer's E-mail Address
City
Siaie
Zip
F— TelephoneF
6. Contractor's Name
Lass
9 `
First Lic. No. j \ 5588 Class
Contractors Address
Contractor's E-mail Address
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St # \�1
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City LAk-e
State C�
Zip
FZ103 L Telephone
OFFICE USE ONLY
6 PERMIT NO. �-_7icSCf7 0 SCD(
TYPE OF CONSTRUCTION
PLAN CHECK NO. � ^ e y u
OCCUPANCY - GROUP
PLAN CHECK FEE $