HomeMy WebLinkAboutF2021-0285 - Permit ApplicationPrint Form /� Worksheet for Fire Permit Application
V N & ® City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # X Zl� Z 1 - 12J [ Fire Sprinkler Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name S� �,� #Units
2. Description of Work
City
State F_ Zip [—� Telephoner----_--
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S Valuation $
Extg Sq Ft r--..----, New/Added Sq Ft F Total Sq Ft
_. State r---- Zip r---- Telephoner------.--
F_ New F Add �b Alter Demo
#Stories
Check Appropriate Box for Applicant/Notification
(- 3. Owner's Name
Last First I—
Owner's Address
Owner's E-mail Address
City
State F_ Zip [—� Telephoner----_--
4. Architect/Designer's
Name Last First F_ Lic. No. F—
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City
_. State r---- Zip r---- Telephoner------.--
5. Engineer's Name
Last ' Firstf-------- Lic. No. F -
Engineer's Address
Engineer's E-mail Address
City
State r_ Zip r_ Telephoned---
6. Contractor's Name
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eeNrLast
Contractor's AddressM\M\�u C""t' IsContractor'sE-mail Address
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State Zip `1ACD Telephone q D"(-
OFFICE USE ONLY
�y PERMIT NO.
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TYPE OF CONSTRUCTION } )( PLAN CHECK NO.
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OCCUPANCY- GROUP
PLAN CHECK FEE $
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