HomeMy WebLinkAboutF2021-0580 - Permit ApplicationWorksheet for Fire Permit Application°��
City of Newport Beach - Building Division
Is O� o
�j _ gg,
di-ng Permit # V �� 1' Y✓ 9O
—J ❑ Fire Sprinkler [ Fire Alarm [ Fire Misc
Address (Not mailing address) Floor
�-Su-it-e-No-
Tenant Name
# Units F
2. Description of Work p
Use �-
-�—
Extg Sq Ft New/Added S Ft Valuation $ C
Sq �� Total Sq Ft � J G
ew ❑ Add [ Alter [ Demo �JJ # Stories
Check Appropriate Box for Applicant/Notification
[ 3. Owner's Name
Last �— —� First
Owner's Address
City---�� State
[ 4. Architect/Designer's Name
Owner's E-mail Address
ZiPF Telephone— I
J
Last ON
Architect/Designer's Address
362-1 �v/1
Cityi State
LIC. No.
Architect/Designer's E-mail Address
ZIPTelephone :Tei4 r23S�Jp J
[ 5. Engineer's Name Last First.
Lic. No.
Engineers Address (Engineers E-mail Address
City State �! Zip -- Telephone—
[' 6. Contractor's Name Last/��� �j� �— First /o
�fP,pjpf%' Lic. No. j�C?jfo''Sjass
Contractor's Address Contractor's E-mail Address
City G State --- --
— — -- --i -_ Zip Telephone 4 1 1-23p Srj�
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
2OZI-033$
K 20,2t-i6ts
PERMIT NO. F202,1 — 05$6
PLAN CHECK NO. V S
PLAN CHECK FEE $