HomeMy WebLinkAboutF2021-0152 - Permit ApplicationWarKbileet for Fire PerntjtApplication
Print Form City of Newport Beach -Building Division
Please print 3 copies F.?®% 1-015,2
Associated Building Permit # ire Sprinkler [ Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
First
Tenant Name # Units
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2. Description of Work
City State F
Use
Valuation $ F
Extg Sq Ft I New/Added Sq Ft I Total Sq Ft
Architect/Designer's Address
Architect/Designer's E-mail Address
# Stories
F_ New F7Add F_ Alter F_ Demo
Zip F_ Telephone—
Check Appropriate Box for Applicant/Notification
Infnrmnfl^n
F- 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City State F
Zip Telephone
F_ 4. Architect/Designer's Name Last First [_ Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip F_ Telephone—
r 5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City State F
Zip F Telephoned
(-6.Contractor's Name Last
First �-en4pw0 Lic. N(5.11-2e(lass
No. /
Contractors
'
ContractorssE-mail Address
Contractors
1 V.5 6 47Z/-eA-'2_tW-V
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City L � _ State
Zip �') 6l L) Telephone '7 & C> - -7;7 9
-26715 _
OFFICE USE ONLY
PERMIT NO.
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TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $