HomeMy WebLinkAboutF2021-0453 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
r Fire Sprinkler F- Fire Alarm F- Fire Misc
1. Project Address (Not mailing address)
Tenant Name rl,�'A T 1 u C A
2. Description of Work
Extg Sq Ft �— New/Added Sq Ft Total Sq Ft
F- New F- Add F- Alter i F_ Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units F
Use
Valuation $
# Stories
F_ 3. Owner's Name Last FA
FirstF
Owners Address
Owner's E-mail Address
ne
City State
�—
Zip F_ TelephoneF—
j_ 4. Architect/Designer's Name Last
FirstF— Lic. No.F
Architect/Designer's Address
Architect/Designees E-mail Address
City — State
F_
Zip F— Telephoned
F_ 5. Engineer's Name Last
First F_ Lic No.
Engineer's Address
Engineer's E-mail Address
City State
F_
Zip F Telephoned
F_ 6. Contractor's Name Last ��Wt z First 1d 4n�a Lic. No. ([ (7c( Class
Contractor's Address
Contractor's E-mail Address
�-1-7
City E�iS State
r(^
Zip To_J a Telephone t � to -'7'zq Zc&-7s
OFFICE USE ONLY
PERMIT NO. /m-1 it
TYPE OF CONSTRUCTION
!
X1/i�%1
OVO� PLAN CHECK NO. VyVIOP
OCCUPANCY- GROUP
�7
� 0 V' PLAN CHECK FEE $