HomeMy WebLinkAboutF2021-0210 - Permit Application- Worksheet for Fire Permit Application oP°R�
Print Form City of Newport Beach -Building Division
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Please print 3 copies
Associated Building Permit# Fire Sprinkler r Fire Alarm FireMisc
1. Project Address (Not mailing address) Floor Suite No
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33 Ste. Y[' -w1 '
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Tenant Name # Units F
2. Description of Work
State F_ Zip r Telephone
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Use
Extg Sq Ft F--- New/Added Sq Ft r---. Total Sq Ft F---',
Valuation $ , Sb a
State [-- Zip F—, Telephone
# Stories I
New F_ Add r Alter r Demo
Engineer's Address
Check Appropriate Box for Applicant/Notification
Information
F- 3. Owner's Name
First U
Last 4�F
Owner's Address
I Owner's E-mail Add s
City
State F_ Zip r Telephone
F_ 4. Arch itect/Designer's Name Last First F_ Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State [-- Zip F—, Telephone
5. Engineer's Name
Last First F_ Lic No.----,
Engineer's Address
Engineer's E-mail Address
City
State F__ Zip r— Telephoned--
F-6. Contractor's Name Last Leray First M,,,\ -y �Lfc No. V(00A', Class[C-I(
Contractor's Address
Contractor's E-mail Address
City
'... State Zip f — Telephons�I—
OFFICE USE ONLY
PERMITNO. �iMjrL bZlb
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TYPE OF CONSTRUCTION
6 Y'( PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
- "- 1 p.rl' 1
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