HomeMy WebLinkAboutF2022-0111 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division o
Please print 3 copies
Associated Building Permit # fT Fire Sprinkler ❑ FireAlarm( r7,
1. Project Address_(Not mailing address) / Floor Suite No
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Tenant Name
T �v�S i� 1 ^silo c W #Units - --,
2. Description of Work s t
Tu^ (YypreV•tw,,} r,,ew va11 Gei1iW Use
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Extg Sq Ft New/Added Sq Ft I Total Sq Ft Valuation $
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# Stories -
[I New F] Add n Alter F7 Demo - - J
Check Appropriate Box for Applicant/Notification
Mformatio^
3. Owner's Name Last First
Owner's Address Owner's E-mail Address
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City �rVW State� Zip ' Telephone
r 4. Architect/Designer's Name Last GAPtJ L First Lic. No. ISS4Z 85
ArchitecUDesignees Address Architect/Designer's E-mail Address
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City M�p�W E State Zip Telephone Ic{� �pCj O�trtr
F-]' 5. Engineer's Name Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City - - State F Zip F- Telephone-
6. Contractor's Name Last ( UL First�y tV L I Lic. No. Class
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Contractor's Address Contractor's E-mail Address
City �(��� G �1 J State �k Zip Telephone
OFFICE USE ONLY 7 ®%% �/��%�yh/� PERMIT NO.
TYPE OF CONSTRUCTION [: l� V v ✓- 1 PLAN CHECK NO.
OCCUPANCY- GROUP\�% /�%.y\ �(%� PLAN CHECK FEE $