HomeMy WebLinkAboutF2023-0078 - Permit Application (3)Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # I rj Fire Sprinkler �i Fire Alarm r; Fire Misc
1. Project Address (Not mailing address)
Tenant Name I� trl�'�i✓i"
2. Description of Work
EMg Sq Ft New/Added Sq Ft Total Sq Ft
r New r Add r; Alter F_ Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
_2_tilr> I
# Units
Use
I�
Valuation
# Stories FIT
ri 3. Owner's Name Last T-P t F, C04MY First
- — -
Owner's Address Owner's E-mail Address
City WA —OT tjj I State Fzj.1�7I Zip /Yiv 0 Telephonel.
r4.Arch itecUDesigner'sName Last t Firstt Uc.No.�—
- -
Architect/Designers Address Architect/Designer's E-mail Address
City State Zip l Telephone.--
r 5. Engineer's Name Last/ First Lic. No. 1
Engineer's Address { Engineers E-mail Address
City b� /Vn State (/ Zip L r 7 Telephone q t�1- 3ot1-i- �60�
rib. Contractor's Name Last �Q �� D�M�j st Lic No. F Class^
Contractor's Address Contractor's E-mail Address
City; State Zip Telephone
- F
OFFICE USE ONLY PERMIT NO. T rZQ 2 3 — 0o7
TYPE OF CONSTRUCTION PLAN CHECK NO. PIC Z013. 0313
OCCUPANCY - GROUP PLAN CHECK FEE $
01