HomeMy WebLinkAboutF2023-0435 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application US
City of Newport Beach - Building Division
r Fire Sprinkler L_, re Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
�`/ ��� t SS3 Nu)paf- Cu1�,2, 6-rvty
I ! /I -ten T I, 70 �J #Units
Tenant Name LL1�f'to(,WI`-� C� I , 7
2. Description of Work
�R
`f„Use�iJ� � 7"
Valuation $ 1p Dea • Da
Extg Sq Ft � New/Added Sq Ft � Total Sq Ft F_�
# Stories F
F_ New F_ Add r✓Alter F_ Demo
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name
Last
Firsb1
Owner's Address
Owner's E-mail Address
City
State r___ Zip
F_ Telephone
r 4. Architect/Designer's Name Last First Lic. No. F
Arch itect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip
F Telephone
r✓5. Engineer's Name
Last ( It- h-%,v
First5 Lic No. F11bIv7,6
Engineers Address
Engineer's E-mail Address
-7.rn sue.
City VUr�� �-
State F" Zip
(40 Telephone �LZ 3S3%i3c>
6. Contractor's Name Last /F.CC— JP st F_ Lic. No. yb9p,/A ClassL -IV
Contractor's Address
Contractor's E-mail Address
375v S44A
&} ee is 990
grtctL,,L irdcv_*U JCity
k^f6 n` e,*State
Zip
WV< Telephone a• 0
OFFICE USE ONLY
PERMIT NO. t ZO1J� •VY�S
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $