HomeMy WebLinkAboutXR2022-1971 - Permit ApplicationPlease print 3 copies
Associated Building Permit #
1. Project Address
Worksheet for Fire. Permit Application
City of Newport Beach - Building Division
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mailing address)
Fire Sprinkler ri Fire Alarm F-; Fire Misc
Tenant NameIE--
2. Description of Work p
Extg Sq Ft F. New/Added Sq Ft _ J Total Sq Ft
New r AddAlter j- Demo v V�
Check Appropriate Box for Applicant/Notification
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Floor Suite No
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#Units r
Valuation $ �pp
# Stories
(-' 3.Owner's Name Last
t�F7 fj� Kr�✓� ! First—
Owner's Address
Owner's E-mail Address
City
State zip �— Telephone
f- 4. ArchitecUDesigner's Name
Last First F Lic. No. �—
Architect/Designers Address
Architect/Designees E-mail Address
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State F zip Telephone
F 5. Engineer's Name Last
First Lic No.�
Engineer's Address
Engineer's E-mail Address
City
State F— Zip �— Telephoned--
I- 6. Contractor's Name Last `/ First (1C� Lic. No�� Class
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Contr ctor's ddress Contractor's E-mail Address C 3
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City Ft4>�c. __ �i/r-(.1 W.. _
_ state - zip.-.9?,,2i.5t IplSdne A:
OFFICE USE ONLY
/J Y' 2/ PERMIT NO.
TYPE OF CONSTRUCTION
O I I D PLAN CHECK NO.
+
OCCUPANCY - GROUP
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PLAN CHECK FEE $
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