HomeMy WebLinkAboutF2021-0633 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division r-20 �0L033
Please print 3 copies
Associated Building Permit#21435YF ❑ Fire Sprinkler ❑Fire Alarm ofireMisc
1. Project Address (Not mailing address) Floor Suite No
°SD 25
---_ WY -- C-
Tenant Name # Units
2. Description of Work
___...-Use.
EMg Sq Ft New/Added Sq Ft Total Sq Ft a.`j �3i
Valuation $
New �d [ Alter F Demo
#Stories �J
Check Appropriate Box for Applicant/Notification
3. Owner's Name
Last �— First �—
Owner's Address
Owner's E-mail Address
City
State Zip F— Telephone j
❑ 4. Architect/Designer's
Name Last �— First—, Lic. No.
Architect/Designers Address
Architect/Designer's E-mail Address
City _
_ State Zip Telephonee--
5. Engineer's Name
Last First Lic. No. �~
Engineer's Address
Engineer's E-mail Address
i
i
City State F Zip F— TelephoneF—
276. Contractor's Name
Last First Lic. No. 73Y(� 7( Class'
Contractor's Address
Contractor's E-mail Address
975City
t / �
State e IF Zip I l' 6 7p 7 Telephone
OFFICE USE ONLY
TYPE OF CONSTRUCTION
RMIT NO.
JWE
P N CHECK NO.
a��,.
OCCUPANCY - GROUP
PLAN CHECK FEE $