HomeMy WebLinkAboutF2021-0299 - Permit Application07Pr� Worksheet for Fire Permit Application �NEW�
4 print
6L91
City of Newport Beach -Building Division � tipZl"
Please print 3 copies
(� Sprinkler Associated Building Permit # r—el(`Fire S
p r Fire Alarm F Fire Misc •4</iORN�P
1. Project Address (Not mailing address)
W M r p�-t Floor Suite No
Tenant Name F Units (------!
2. Description of Work
Use
Extq Sq Ft r---' New/Added Sq Ft r------- Total Sq Ft Valuation $
j� �,
�; New I K Add Alter ( Demo #Stories
Check Appropriate Box for Applicant/Notification
Ow 3.Owner's Name
Last
1 � t P_C_ V_P (-I FF i First
Owner's Address --
Owner's E-mail Address
�/��a�7 T yr o//��a,
City [Mv �Or-r L17 _ State I \' Zip -- Telephoner—___
1`7 4. Architect/Designer's Name Last First r-------'
Lic. No. �—_-v--_�'
Architect/Designer's Address Architect/Designer's E-mail Address
City -_-. .._ State F_.. ZiP Telephoner---- -... -
❑ 5. Engineer's Name Last First r --- —
Lic No.
Engineer's Address
Engineer's E-mail Address
City _ _ State I_ Zip Telephoner—
_. --__-_—
L
ame Last U V C �
First �J(..1 Lic No• l o l la l6 0 ' Class C - 1(O
VV
Contractor's E-mail Address
cbQ �OS_t�s log _ Srtac�e ' ctxfiPPO �tPcfian,or-n
i Y" ntC _ State r?� Zip
71D-_ Telephone ) 1(7 'D3-71
=ONLY PERMITNO. PLAN CHECK NO.
PLAN CHECK FEE $