HomeMy WebLinkAboutF2021-0471 - Permit ApplicationWorksheet for Fire Permit Application US,`
Print Form City of Newport Beach -Building Division g�Please print 3 copies Ol 76
Associated Building Permit # 2�'L j -) j�/, r, Fire Sprinkler Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name lEy f r E #Units
2. Description of Work YYY
COL) ,Z 10aM, Use
Extg Sq Ft �— New/Added Sq Ft Total Sq Ft / ✓'3 - Valuation $ �� �[ i5E
v
New F_Add ^� Alter F_Demo # Stories
Check Appropriate BOX for Applicant/Notification
F_ 3. Owner's Name
Last First F_
Owner's Address
Owner's E-mail Address
City
State F Zip Telephone
r 4. ArchitectlDesigner's Name Last First F Lic. No. F---!
ArchitectIDesigner's Address
Architect/Designees E-mail Address
City
State �j Zip [_ Telephoned
r 5. Engineer's Name
Last First Lic. No. F
Engineer's Address
Engineer's E-mail Address
City
State F_ I Zip Telephoner
6. Contractor's Name Last ���� (LV First N `7 1 Lic. No. % Class ((�J
Contractor's Address
Contractor's E-mail Address
7�2 L'(U_1A
City 1 113" LW j,\,fa_
State , Zip (� 1 Telephone _ F/ a)
OFFICE USE ONLY
•
PERMIT NO. CPT it
"'( 'TV"
TYPE OF CONSTRUCTION
`� t PLAN CHECK NO.
OCCUPANCY- GROUP
�202- L 6'kR4 PLAN CHECK FEE $