HomeMy WebLinkAboutF2022-0137 - Permit Application (2)Worksheet for Fire Permit Applica
City of Newport Beach -Building Division
3 copies
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ed Building Permit # I Fire Sprinkler ❑
J p ' Fire Alarm Fire Misc
Address (Not
100 9atAvlgW Q rrG C
Tenant Name SWtii RC0.� EStt?tC —_
2. Description of Work
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EMg Sq Ft� 1 New/Added Sq Ft 1 JI Total Sq Ft Z,nc j l
❑ New F. Add g Alter [] Demo
Check Appropriate Box for Applicant/Notification
Floor
L— i
Suite No
220
# Units
F-77
Valuation $z ij.OQ
#Stories I fo I
❑ 3. Owner's Name Last �— — First
Owner's Address Owner's E-mail Address
City State Zip Telephone
❑ 4. Architect/Designer's Name Last__ — I First
Architect/Designees Address Architect/Designer's E-mail Address
city ! State—I Zip [---�, Telephone[ --------- r
❑ 5. Engineer's Name Last First
[7777—
Lic. No.
Engineer's Address Engineer's E-mail Address
City �— State ZipTele hone
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�6. Contractor's Name Last �OhY1SiOtl J First �9hY1 42
------------------ - _ _ _ Lic. No. 9943 ' Class
C
ntractors Address Contractor's E-mail Address
mot 'Koymat Koack &u k -K john @ ailpto Fitcinc. cem
City QC2gY)V _--- —' State Opt Zip o1205B — Telephone 95L -----
OFFICE USE ONLY �\
P RMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO. t
OCCUPANCY - GROUP
PLAN CHECK FEE $
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