HomeMy WebLinkAboutX2022-0188 - Permit ApplicationWorksheet for Fire Permit Applicatio ul",City of Newport Beach -Building DivisionPlease print 3 copies
Associated Building Permit# Fv�/FireSprinkler ❑Fire Alarm ❑ Fire MiD(q
1. Project Address (Not mailing address)
Floor Suite No
(OSS
CA c • Qr.
Tenant Name
i MF �Qw
#Units F7
2.r Description of Work
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip � Telephoned
0Mq_ (lick (Lr
First F77-71 Lic. No.
Engineer's Address
Use
City State
Zip Telephone
Valuation$"dam
Firstyn.� VJ Lic. No. i$ lass
Extg Sq Ft
New/Added Sq Ft F777
TotalSq Ft �Ln
[7 New
❑Add ❑Alter [7 Demo B
S t�(�
'II - 6 - S"
I /
#Stories I I
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last ThCL DVW^ First
Owner's Address
Owner's E-mail Address
CityF�Yt 't n State
Zip F777777 Telephoned
❑ 4. Architect/Designer's Name Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip � Telephoned
❑ 5. Engineer's Name Last
First F77-71 Lic. No.
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephone
[J-6. Contractor's Name LastZou�
Firstyn.� VJ Lic. No. i$ lass
Contractor's Address
Contractor's E-mail Address
City V" ' �� l M State C
!
Zips TVelephone �j (c� } p of ci
OFFICE USE ONLY ID204, -b03 j PERMITNO. XoZ011 -01%W
TYPE OF CONSTRUCTION
PLAN CHECK NO.OCCUPANCY-
GROUP
PLAN CHECK FEE $