HomeMy WebLinkAboutX2021-0202 - Permit Application (2)Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies A,2®'2 J . 0,20:
Associated Building Permit # h Fire Sprinkler D Fire Alarm (, Fire Misc
1. Project Address (Not mailing address) Floor Suite No
_________----IMOD--SCD-_-__5 -.-_2` ___ _._ --- _-_J I--
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Tenant Name # Units
Owner's Address
2. Description of Work
Use � I
Extg Sq Ft New/Added Sq Ft F Total Sq Ft �,
Valuation $ IZ��iO
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F'[New r—' Add [`i Alter FDemo
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# Stories i------- �
Check Appropriate Box for ApplicantlNotification
F-13. Owner's Name Last �D
- -- _ First -
Owner's Address
Owner's E-mail Address
Cityr-. �Yvj.-. State
Zip Tty, Telephone��N
4. Architect/Designer's Name Last
First—,
--
Lic. No. --_'--i
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
i
City State—,
Zip Telephone
F- 5. Engineer's Name Last f —
- First F7777
Lic.No.��
Engineer's Address
Engineer's E-mail Address
City State
F_ Zip F Telephoner_—
( 6. Contractor's Name Last ri(jr(j �(tjfj�ltgrst�—--' Lic No. �(p'G�l� Class Ctb
Contractor's Address
Contractor's E-mail Address
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City State—.
Zip Telephoned
OFFICE USE ONLY
PERMIT NO.
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TYPE OF CONSTRUCTION
PLAN CHECK NO.
bZlS °2D� j
OCCUPANCY - GROUP
PLAN CHECK FEE $