HomeMy WebLinkAboutF2022-0332 - Permit Applicationv
Worksheet for Fire Permit Application owr
City of Newport Beach - Building Division
Please print 3 copies c;,oae�
Associated Building Permit # I _j Fire Sprinkler ❑ Fire Alarm F Fire Misc
1. Project Address (Not mailing address) Floor Suite No
27S1 13v�5��re Dr C—
Tenant Name '� # Units
2. Description of Work
-Use
Use
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Valuation $
Extg Sq Ft �_ J New/Added Sq Ft Total Sq Ft Z'] Z _
ITT New E Add ❑ Alter [ Demo # Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last First
Owner's Address
Owner's E-m '' ddress
City I State �— Zip— Telephone j
4. Architect/Designer's Name Last _ � � First _ Ij Lic. No.
Architect/Designer's Address Architect/Designers E-mail Address
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CiTy State �—` Zip Telephone
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r 5. Engineer's Name Last First Lic. No.
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Engineer's Address Engineer's E-mail Address
City State Zip Telephone
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[' 6. Contractor's Name Last First �fi Lic. No. I Class l (�
Contractor's Address IIContractor's E-mail Address
Z2-6-7Z LAK-bW S T �Di�. Ll�(S}cr c�% glymail.cd,
City LInk2 State Cii _ Zip G2630 Telephone a��j7O 7
OFFICE USE ONLY y YY PERMIT NO. 1'�LO�n�,33Z
TYPE OF CONSTRUCTION _ 1 �'Z PLAN CHECK NO.
OCCUPANCY - GROUP �21 0Zq PLAN CHECK FEE $