HomeMy WebLinkAboutF2023-0254 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
1. Project Address (Not mailing address)
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Tenant Name D
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2. Description of Work
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iT, Fire Sprinkler j— Fire Alarm r Fire Misc
Extg Sq Ft go New/Added Sq Ft F Total Sq Ft�—
r New r Add Alter r Demo
t:necK Appropriate Box for Applicant/Notification
Floor Suite No
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# Units I
Use f /ylP/CEaK:it•, ���.
Valuation $ F3, oc O
# Stories 5
i— 3. Owner's Name Last
First �—
Owner's Address
Owner's E-mail Address
city State
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Zip Telephone—
r 4. ArchitectlDesigner's Name Last
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First I— Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
city I— State
F_
Zip F_ Telephoned—
r 5. Engineer's Name Last
First 7— Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City �— _ State
�—
Zip �— TelephoneF_
6. Contractor's Name Last C
First D�n�! Lic No. 5SGlass
Contractor's Address
Contractor's
Contractors E-mail Address
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City /yi 1' l� rt� y State
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Zip rq Telephone'(`� '3� q, L (yy
OFFICE USE ONLY n I _ bzo a PERMIT NO.
TYPE OF CONSTRUCTION
v J
PLAN CHECK NO.w�7
OCCUPANCY- GROUP
PLAN CHECK FEE $
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