HomeMy WebLinkAboutF2021-0239 - Permit ApplicationLE-HWorksheet for Fire Permit Application ze=24
City of Newport Beach - Building Division rS
Please print 3 copies
)" ()21 j ry^�//o
Associated Building Permit #
._ �h JCl oas"
Fire Sprinkler ire Alarm r-- Fire Misc
I
.ss (Not mailing address)
—Floor Suite No
_.... # Units Fof Work-��'�-1 �Lk �g ,,L Use
-- New/Added Sq Ft I---_ -- Total S4 Ft--- — —', Valuation $ SS��
F_ New j- Add r"; Alter Demo # Stories
Check Appropriate Box for Applicant/Notification
Infomafm
F_ 3. Owner's Name Last i First r- -----.---
Owner's Address
Owner's E-mail Address
City_... _ _.. ...State.. ZIP �� Telephoner._-._-_--_____
::
r -i 4. Architect/Designer's Name Last
-. - First r_._.-- -_ Lic. No.--_--_._
Architect/Designer's Address Architect/Designer's E-mail Address
City I State r___ Zip F_ Telephoner.____.-_
5. Engineer's Name Last First f ------
Lic. No. [— --
Engineer's Address
Engineer's E-mail Address
City ..._ __ _.... ....State Zip
L._.__-_.-_ Telephone_.__._--- '
6. Contractor's Name LastI-- - -'
�� �S �-'�� First I �� Lic. No. �I& C, o Class[/-:7—
Contractor's
lass /c,Contractor's Address
Contractor's E-mail Address _
City
State -- ZiPr_-__._._ Telephone /yl�%i '_�/
OFFICE USE ONLY y PERMIT NO. J
TYPE OF CONSTRUCTION _ >i��L
PLAN CHECK NO.
OCCUPANCY -GROUP D1-11 LALI
PLAN CHECK FEE $