HomeMy WebLinkAboutF2021-0218 - Permit Applicationn 4 —0 -1 / } Worksheet for Fire Permit Application
Please Print 3 � �cop 5 �'`� I y City of Newport Beach - Building Division
Associated Building Permit # 7_
1. Project Address (Not mailing address)
Tenant Name
i2.. Description of Work
Fire Sprinkler n Fire Alarm n Fire Misc
Extg Sq Ft'' New/Added Sq Ft r--71
Total Sq Ft
F' New ( AddAlter
i [Demo
::neck Appropriate Box for Applicant/Notification
13- Owner's Name Last
Owner's Address p� AF 14
I_��%� "� --- Owner's E-mail Address
I City
i
4. Architect/Designer's Name
/`Architect/Dasigner's Address
J
city
1,t'`n 5. Engineer's Name Last
.Engineer's Address
01
City/—
r!6. Contractor's Name Last
Floor
#U
Suite No
Use P�� PVT
Valuation $
# Stories
State71
—_I V Zip Telephone(_7._._,_-___'
Last ( I
•� I-4-4�-9 i �... ... First r) n (✓ ,I
�/_ 1 � Lic. No. �7-t17
Architect/Designe s E-mail Address !i
'a i State Zip /� I✓ --
- --
61 Telephone
- Telephoner
First
Lic. No,
Engineer's E-mail Address
2 ✓ ILLC kP t�1
StateZ� i / /✓ t p ----;
i G� / Telephone(—�y—',i
-'
Kl�
�umraetors Address
City r-q---=--
-C�� State—,
OFFICE USE ONLY r
TYPE OF CONSTRUCTION S '
OCCUPANCY - GROUP
Lic. No. '
�__� `�(� Class(..%.�,
Contractor's E-mail Address
Zip Tele hone
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEE $