HomeMy WebLinkAboutF2021-0090 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division F 7,0,2,1 _ 0 0 %0
Please print 3 copies
Associated Building Permit# 2(} IQrj� F-1 Fire Sprinkler r Fire Alarm (1Fire Misc
1. Project Address (Not mailing address) Floor Suite No
First—,
Tenant Name S` KK Sy �,� �• #Units
2. Description of Work
Zip F� Telephone[�
Use
Extg Sq Ft �— j New/Added Sq Ft p Total Sq Ft
i
Valuation $ I SOb
Architect/Designer's
ce ct/Designer's E-mail Address
i
City -. State—,
F7 New r Add r Alter r Demo
# Stories
Check Appropriate Box for Applicant/Notification
[i 3. Owner's Name Last �—
First—,
Owner's Address
__-
Owner's E-mail Address
City I State F
Zip F� Telephone[�
� 4. Architect/Designer's Name Last _.�—
I First— Lic. No.� s
Architect/Designer's Address
Architect/Designer's
ce ct/Designer's E-mail Address
i
City -. State—,
Zip ��l Telephoned
[', 5. Engineer's Name Last I
First LicNo.
Engineer's Address
Engineer's E-mail Address
City r - StateF
Zip ��; Telephone(_�
f 6. Contractor's Name Last ,Q�2First ��p� Lic.No. (%�j 3�'�2Class�j�
/ `
Contractor's Address
Contractor's E-mail Address
City ''I y �crdl9 _G'4� State f :
`+`C
Zip F % si._ Telephone c/[✓9 �/�2.-�%/ 9^�..
OFFICE USE ONLY
PERMIT NO. OC) c( '
TYPE OF CONSTRUCTION
PLAN CHECK NO. D6 -12
OCCUPANCY - GROUP PLAN CHECK FEE $
. `L07 k - o 0-7S
T\_.:Z 5� > cl -73 Zl2g, Z2