HomeMy WebLinkAboutF2021-0189 - Permit Application' =Worltsheetfor Fi'r`e PirrWitApplication
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # I r Fire Sprinkler r Fire Alarm r Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
CC' t C�P� Ie SF b cam✓ _ / /('i %
Tenant Name # Units
2. Description of Work
City r
N 1i,A
I
Use
First Lic. No. F
Valuation $ / c, & cp
Extg Sq Ft New/Added Sq Ft Total Sq Ft
'
New FI Add ) Alter F7 Demo
# Stories F/
Check Appropriate Box for ApplicanUNotification
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F 3. Owner's Name Last �
,First
Owner's Address
Owner's E-mail Address
City r
State �—' Zip Telephoned
F_ 4. ArchitectlDesigner's Name Last
First Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State r Zip Telephone—
F_ 5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State , Zip F— Telephone
F_ 6. Contractor's Name Last �(r�r ��c First Lic. No. j�,7 jo7 CjassF0
Contractors Address
Contractor's E-mail Address
City I par, u"j t p+
State Zip �i� o s TelephoneF7� c �J gC
OFFICE USE ONLY PUI-/ ;:J PERMIT NO. 74.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
Iy I3 PLAN CHECK FEE $ �d
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