HomeMy WebLinkAboutX2021-2509 - Permit Application (2)Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # K Fire Sprinkler ❑ Fire Alarm [ Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
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Tenant Name �y 2 # Units F_
2. Description of Work
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Ext S Ft New/Added S Ft
9 q q �- Total Sq Ft—
Valuation $
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# Stories M
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Check Appropriate Box for Applicant/Notification
❑3. Owner's Name Last ����� First
Owneerps Address Owner's E-mail Address
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City State pg— ZipTelephone
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4. Arch itect/Designer's Name Last �— — _ I First F Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City _ State— Zip Telephoner
F 5. Engineer's Name Last First 177777—.
Lic.No.I i
Engineer's Address Engineer's E-mail Address
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City — State— Zip —.i Telephone��-
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—'S. Contractor's Name st�.i rOJJAk. �J1cp� vlE�'r rt q F Lic. rN.o�I. CZl2a^ss
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City q 1. State Zip .lephone�3 25/
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OFFICE USE ONLY PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP • PLAN CHECK FEE $
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