HomeMy WebLinkAboutF2021-0228 - Permit ApplicationPrint Forrri Worksheet for Fire Permit Application
r /yt J 022 d City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # r Fire Sprinkler r Fire Alarm r Fire Misc
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1. Project Address (Not mailing
((address) Floor Suite No
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Tenant Name s # Units I r
2. Description of Work
Use
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Valuation $ I
Extg Sq Ft ��New/Added Sq Ft F Total Sq Ft
New F -Add Alter r Demo
# Stories F
Check Appropriate Box for Applicant/Notifica
tion
Information
F- 3. Owner's Name Last
Owner's Address Owner's E-mail Address
City State F_ Zip F— TelephoneF—
r 4. Architect/Designer's Name Last First F_ Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State �� Zip F—, TelephoneF—'
F_ 5. Engineer's Name Last First �— Lic. No. F
Engineer's Address Engineer's E-mail Address
City State F__ Zip F— TelephoneF—
j- 6. Contractor's Name Last e—re- . r X First L, &S Lic No. I FSO-fS Class
Contractor's Address Contractor's E-mail Address
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City �+l°�. C State P57;4-4— Zip 4g25Telephone ��_RF-Nc Q�,
OFFICE USE ONLY PERMIT NO. 1�9.i1 �il • �%21
TYPE OF CONSTRUCTION —m �°�p�.b(pgp PLAN CHECK NO.
PLAN CHECK FEE $
OCCUPANCY -GROUP