HomeMy WebLinkAboutF2021-0338 - Permit Application7ffI� 11��
!/" �I �� Worksheet for Fire Permit A lication3�U 04� °
t`°�Pnnt,Form '' Pp
City of Newport Beach - Building Division
Please print 3 copies r /;
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Associated Building Permit # r Fire Sprinkler r fe Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name # Units
2. Description of Work
Use
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Extg Sq Ft — --Valuatio $
New/Added Sq Total Sq Ft r----.------�,
r New r Add r Alter Demo # Stories
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F_ 3.Owner's NameLast
e S e (
First
Owner's Address
Owner's E-mail Address
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City
State C./�
Zip °I Z e, Ic( Telephone `j– pppppp��'�
F,-, 4. ArchitecUDesigner's
Name Last First r-- � Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State r_—_
Zip Telephoner _...
r1 5. Engineer's Name
Last
First---- �!
Lic. No.
Engineer's Address
Engineer's E-mail Address
City � _. _
_.. State
Zip Telephoned____—.._ _._. _..
r6. Contractor's Name
Last N2(5eFirst .�s� Lic. No. 7)Class f. )p
Contractor's Address
Contractor's E-mail Address
City
�vur n e
State G /7- _
Zip "( Z Cee (i Telephone q((q'
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PERMIT NO.
STRUCTION
GROUP
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PLAN CHECK NO.-
PLAN CHECK FEE $ — r