HomeMy WebLinkAboutF2022-0004 - Permit Application`Worksheet for'Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies 000
Associated Building Permit # x�/ a [� c{F jD Z_F Fire Sprinkler F_ Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
1170,1172 7-//7-5 ki?8ew_ Z6,?&__ !
Tenant Name # Units
2. Description of Work
Owner's E-mail Address
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Extg Sci Ft New/Added Sci Ft F Total Scl Ft
Valuation'$P-473 t
New F_ Add rl Alter F- Demo
# Stories F
Check Appropriate Box for Applicant/Notification
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7 3. Owner's Name
Lasti4racmp ,�eS I FirstF -',
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Owwneer's Address
Owner's E-mail Address
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City � C )_ z X
State 1 �
Zip -6 Telephone a�
F_ 4. Architect/Designees Name Last 1v&w
First Lic. No. F
Architect/Designees Address
Architect/Designees E-mail Address
City
I State F_—
Zip [— Telephone
F_ 5. Engineer's Name
Last Mendoza
First =Sftl9e l Lic. No. F
Engineer's Address
Engineer's E-mail Address
4154) J 1,0L.j�( ;
City
State
Zip 7 Telephone 7/k-&45-. //&G(
6. Contractor's Name Last First Lic. No. 8373 Class FQO
Contractor's Address
Contractor's E-mail Address
city I 1 0Y0/1lti __
State [6#
Zip � g Telephone tbl. ab+ OQS5
OFFICE USE ONLY
PERMIT NO. YZZ - t�C>C7`I
TYPE OF CONSTRUCTION
PLAN CHECK NO. L /� 0 Z'7
OCCUPANCY - GROUP
SCOB n-sWS VA*
PLAN CHECK FEE $