HomeMy WebLinkAboutF2021-0604 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building �
Please print 3 copies ���///���///
Associated Building Permit# Our✓j Fire Sprinkler [71' Fire Alarm
❑ Fire Misc
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1. Project Address (Not mailing address)
Lai 2 -
Tenant
Tenant Name l��.0 it 5fi
Last �— First
Floor Suite No
# Units
2. Description of Work
City - —
_ State F-7 Zip F Telephone J�
[I 4. Architect/Designer's Name Last — - First�— Lic. No.
V i�STA i, i_ N ; vJ t PrA i3�
F 1 ]zE s�'�1�11eL n s ...I
Use Z�;J t7L
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$ '?j CJ V T11
#Stories
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-Valuation
Extg Sq Ft F ----.,i New/Added Sq Ft �- Total Sq Ft ff�518.2
R(New ❑Add ❑Alter [Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name
Last �— First
Owner's Address
Owner's E-mail Address
City - —
_ State F-7 Zip F Telephone J�
[I 4. Architect/Designer's Name Last — - First�— Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City — State 177 ZipF_Telephone
[ 5. Engineer's Name
Last First �—Lic. No. i
Engineer's Address
Engineer's E-mail Address
City _—
— State—, Zip �� Telephone—
[6. Contractor's Name Last—
�—
First Lic. No. 1'%zcf Class (;(
Contractor's Address
Contractor's E-mail Address
1L(2 EN(tTA
City I 541\( Q UVIAS_ -
-- State r Zip(, '7 Telephone 3ro�
OFFICE USE ONLY
PERMIT NO. :�LO- C�7C"7C��i
TYPE OF CONSTRUCTION
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PLAN CHECK NO. L6 %
L7 - L.el
OCCUPANCY - GROUP
1C PLAN CHECK FEE $