HomeMy WebLinkAboutF2022-0579 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler r; Fire Alarm (;Fire Misc 5`&
1. Project Address (Not mailing address) Floor I Suite
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te N
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Tenant Name #Units
2. Description of Work
Use
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SP(�INIc-c r� S9S �v�-.
Extg Sq Ft New/Added Sq Ft �Total Sq Ft ���Valuation $ -- � - - -
V4 New r Add F Alter F_ Demo # Stories 1i
Check Appropriate Box for Applicant/Notification
[- 3. Owner's Name
Last First
Owner's Address
Owner's E-mail Address
i
city State Zip F7777 TelephoneF—
r— 4. Arch itectlDesigner's
Name Last , First Lic. No.
Architect/Designees Address
Architect/Designer's E-maii Address
City
State Zip �— Telephoned--
F_ 5. Engineer's Name
Last (��l ��r� First -3( _A_t 4_- Lic. No. (--
Engineer's Address
Engineer's E-mail Address
loySanr i=rrg�krrt_
City �/�
- State �— Zip Telephone %1''l- t733 _ 09 0
I— 6. Contractor's Name
Last (Z First Sl fity Lic No. F- � 3 Class / G
Contractors Address
Contractor's E-mail Address
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City
State �— Zip P�aG�1�. Telephone �I�p�o7 •-15�,�
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO. IRG ZoZZ
OCCUPANCY - GROUP
PLAN CHECK FEE $