HomeMy WebLinkAboutF2021-0276 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
Tenant Name I KeA-5sy
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#Units
2. Description of Work
Use S.oQe.�ic�
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Al ads
46 c
Extg Sq Ft
,2. ZZ /o
New/Added Sq Ft (( ro Ft FZI 7
Valuation $ �{ SOO
t
Sp
New � Add
F_ Alter F_ Demo
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# Stories I
Check Appropriate Box for Applicant/Notification s /V
Information
r 3.Owner's Name Last
First
Owner's Address
Owner's E-mail Adii resg7
City
State f Zip F_ Telephoned
F_ 4. ArchitecUDesigner's Name
Last S �� First AI40 V11 Lic. No.
Architect/Designers Address
Architect/Designers E-mail Address
1JZS rV• quM e io %`Fc-s{ t��t"�es) CCtvl,
City �Kc�C
State Zip Telephone (4
F_ 5. Engineer's Name Last
First F_ Lic. No.
Engineers Address
Engineer's E-mail Address
City
State F_ Zip 7— Telephoned
F_ 6. Contractor's Name Last ��Gc �� First WA Lic. No. Class C,(6
Contractor's Address
Contractors E-mail Address
V325"k). IW ( u,
I Aa1-"� 7,rsk�F(gswtG,(,CCth.
City %�,tne�
State Zip ^i ZTCi(p Telephone 71u
OFFICE USE ONLY
PERMIT NO. Q /—� RW
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
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