HomeMy WebLinkAboutF2022-0144 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler — __ — —_-- _ j p [Fire Alarm [Fire Misc
Address
Tenant Name _
Q
2. Description of Work
Extg Sq Ft 1I 9 O O New/Added Sq Ft qO.
New Add Alter r Demo
Check Appropriate Box for Applicant/Notification
1%3. Owner's Name
Total Sq Ft 3
LastL (,1 M= jL�„ —_� First
Owner's Address =�-
Owner's E-mail Address
2bDfj
city r--
tAr u T
State 1 Zip D Telephone
Floor
Suite No
L
ft Units
Valuation $ j q bql n i
# Stories F
[4.Architect/Designer'sName Last Uri l�-
-—.i/'�---fu{.p�.c ✓I� First Lic. No. i
ArchitecUDesignersAddress —TinC — LLL
Architect/Designer's E-mail Address
2U�tG Cues 54
i, 1�
City WoGl1 LIB — --�
ct State
i— ..Zip Telephone O
5. Engineer's Name Last -- First--
_ Lic. No.
Engineer's Address
Engineer's E-mail Address
City ----- Zip
- — ------
State r--
TelephoneF—'
fZ6. Contractor's Name Last
Contractor's Address
_6
—-------- -----
City Gti3OoD��t' ��5 State
OFFICE USE ONLY
Contractor's E-mail Address
-t---- - U 4e_A1
Zip 6 "T Telephone � Ir� ._Ikr �1� 6r 1
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
020tc,- .
PERMIT NO -
PLAN CHECK NO.
PLAN CHECK FEE $