HomeMy WebLinkAboutF2024-0077 - Permit ApplicationWorksheet for Fire Permit Application uq—,
Print FormCity of Newport Beach -Building Division
Please print 3 copies
Associated Building Permit# I Fire Sprinkler F_ Fire Alarm r Fire Misc
1. Project Address (Not mailing address) \ Floor Suite No
Tenant Name V n # Units �-
2. Description of Work
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Valuation $
Extg Sq Ft Z3 t 7, New/Added Sq Ft F Total Sq Ft f -?
r New F- Add Alter # Stories F
j` r Demo
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name Last
First F
Owner's Address
Owner's E-mail Address
City
State F_
Zip— TelephoneF_
i— 4. Architect/Designer's Name
Last FirstF_Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State F—
Zip F_ Telephone—
r 5. Engineer's Name Last
First F Lic No. r._
Engineer's Address
Engineer's E-mail Address
City
State F—
Zip F— Telephoned
r 6. Contractor's Name Last
Corp
First �; r`(- / Lic No. q -v5-Class
Contractor's Address
Contractor's E-mail Address
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City �ji� a,/ r y
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State74
Zip /%a Telephone �!/� - Dly�1
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OFFICE USE ONLY
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TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
(t� I
1 -� PLAN CHECK FEE $