HomeMy WebLinkAboutF2021-0123 - Permit ApplicationWorki§hedt for Fire Permit, Application
Print Form
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-- City of Newport Beach - Building Division
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Please print 3 copies
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Associated Building Permit# �/_ �(� (- Fire Sprinkler (-Fire Alarm
F- FireMisc L�/_ �� S
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1. Project Address (Not mailing address)
Floor Suite No
1519 &S7- 13a,l 4-vi
7— F—
Tenant Name �v� J)���N ae$ (Zi
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2. Description of Work
Use
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Extg Sq Ft �� New/Added Sq Ft Total Sq Ft
Valuation$ F33Ou.u_
# Stories
r New (- Add TyAlter (- Demo
Check Appropriate Box for Applicant/Notification
Informafmon
r 3. Owner's Name
Last �L Firsts
Owner's Address
Owner's E-mail Address
City
State F_
Zip Telephone
F_ 4. Architect/Designer's
Name Last
First F__ Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_
Zip F— Telephone
` 5. Engineer's Name
Last I /Z S S U✓N
First vl �� Lic. No. �—
Engineer's Address
Engineer's E-mail Address..
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City Vj1AN6/I:
State f --C,—
Zip �'� Telephoned
F- 6. Contractor's Name
Last J(CLt j
First SI;�N Lic. No. 7firl) Class /(o
Contractors Address
Contractor's E-mail Address
10 l.1-(l elw5fur
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City bvtir. Dt/k
State
Zip q Telephone I&f, GAD _ lSFG
OFFICE USE ONLY
PERMIT NO. �"_ZOZA ^ 0 12b
TYPE OF CONSTRUCTION
PLAN CHECK NO. O 7ZI - %Z(
OCCUPANCY - GROUP
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PLAN CHECK FEE $
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