HomeMy WebLinkAboutF2021-0083 - Permit Application (2)Worksheet for Fire Permit Application WH m
City of Newport Beach - Building Divisioy
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Associated Building Permit # �- I [�q Fire Sprinkler [Fire AlarmtYlsc
1 Project Address (Not mailing address)
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Floor
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Tenant Name i1/J2 (J ✓ - 5 GQ(vl
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2. Description of Work
City State
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F7 5. Engineer's Name Last Uy�
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EMg Sq Ft F I New/Added Sq Ft Total Sq Ft
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Valuation $
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( New j- Add r Alter r Demo
[76. Contractor's Name Last (�
# Stories
C:neck Appropriate Box for Applicant/Notification v
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( _i 3. Owner's Name Last �—
' First
Owner's Address
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Owner's E-mail Address
city J State F—i
Zip r� Telephone F_
F7 4. Architect/Designer's Name Last --,'First
First � Lie. No. F7
Architect/Designer'sAddress
Architect/Designer's E-mail Address
City State
Zip (---'-a---' Telephone
F7 5. Engineer's Name Last Uy�
First '
Engineer's Address
Engineer's E-mail Address
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[76. Contractor's Name Last (�
First SN Lic. No. �7��� �; Class
Contractor's Address
Contractor's E-mail Address
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Zip�.�G�9G Telephoner7�go..-75O(�
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OFFICE USE ONLY C��
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY -GROUP ��� z�
`� PLAN CHECK FEE $
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