HomeMy WebLinkAboutF2022-0156 - Permit ApplicationWorksheet for Fire Permit Appli�����r�������aa�aa}+}+}++++}}}i
City of Newport Beach - Building Divisio��j o
Please print 3 copies
Associated Building Permit # Fire Sprinkler ❑ Fire Alarm F- Fire Misc
1. Project Address (Not mailing address) Floor Suite No
A00 C
Tenant Name — — _ #Units F
2. Description of Work
Valuation $�� Q�
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Extg Sq Ft New/Added Sq Ft —� Total Sq Ft
[-j New [ Add Alter F_ Demo
# Stories F
Check Appropriate Box for Applicant/Notification
1 nfnrm Minn
C 3. Owner's Name Last/ a-� First—,
Owner's Address Owner's E-mail Address
100 z36
City �_ � � - _- State F Zip �266�-_- Telephone 1
_ �l $ X26 S-2�Ft
[, 4. Architect/Designer's Name Last Pfo-- ✓� �d 2_ rvl� First— Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State �- Zip & � Telephone c5;1 ZY�_ �36
5. Engineer's Name Last f a4AS71py O/jh First Lic. No, 2 93
Engineer's Address Engineer's E-mail Address
City _ _ State—', Zip Telephoned
[6. Contractor's Name Lasti
F;ef First— Lic. No.
- - - -- -- ----- Class I
Contractor's Address Contractor's E-mail Address
City $ State �— Zip 9LO Telepho e r'fS 2J1, /e
OFFICE USE ONLY PERMIT NO. FZOZZ -
TYPE OF CONSTRUCTION — PLAN CHECK NO. 076 Z' 71�ZZ
OCCUPANCY - GROUP I✓ �Z��G�S / PLAN CHECK FEE $
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