HomeMy WebLinkAboutF2021-0452 - Permit ApplicationPrint Form Worksheet for Fire Permit Application 0"« _"e
-- City of Newport Beach - Building Division q
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Please print 3 copies
Associated Building Permit # (j Fire Sprinkler F_ Fire Alarm F_ Fire Misc
1. Address (Not address) Floor Suite No
fProject pmailing
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Tenant Name
U�Q # Units
2. Description of Work
Use
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Extg Sq Ft F New/Added Sq Ft Total Sq Ft
Valuation $ 15 O
New F_Add (— Alter F–Demo
# Stories
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last N t First TO F -GI
Owner's Address
Owner's E-mail Address
City C������ �CI _"a State F zip Telephone
F– 4. Architec esigner's Name Last �1 I /J First Lic. No. r !
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Architect/Desi eros Address
Architect/Designer's E-mail Ad ess
City
State F—Zip F_ TelephoneF_
F_ 5. Engineer's Name Last First 7 Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City
State F -- Zip F— Telephoner
6. Contractor's Name Last FirstF Lic. No. `v i �,�%�I Class
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Contractor's Address
P 1 e Contractor's E-. ail Address
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Mr S StaC�e ' cofif'/Cvrct�Ct�on w
City I �'ay\ C lX U vt
State lF ' Zip q2b "13 TelephoneF9 Ll; 7 71 n P� 3 -7)
OFFICE USE ONLY
, Zv�v PERMIT NO.
TYPE OF CONSTRUCTION
�%%� fj 7 f �j�� PLAN CHECK NO. VOL
OCCUPANCY - GROUP
nnV PLAN CHECK FEE $