HomeMy WebLinkAboutF2021-0490 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies C' 10}t ' Cr Oo
Associated Building Permit# j Fire Sprinkler ❑Fire Alarm Fire Misc
1. Project Address (Not mailing address)
Tenant Name
2. Description of Work
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Floor Suite No
# Units
Valuation $
Extg Sq Ft !' New/Added Sq Ft Tot q t
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b) F7 New j` Add C Alter j-'i Demote l b���� ,4 # Stories
Check Appropriate Box for Applicant/Notification
3. Owner's Name
Last y�
i �✓1%� �' 'P First
Owner's Address
Owner's E-mail Address
City e
14 State F��� Zip Z%��Telephone
j— 4. Architect/Designer's
Name Last �— First[ Lic. No.
Architect/Designer's Address
Architect/Design&s E-mail Address
City -.
-.--_ State �— Zip �— Telephone[—
5. Engineer's Name
Last First Lic. No.
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Engineer's Address
Engineer's E-mail Address
City �— _ _ _ State �— Zip �; Telephone
r6.Contractor's Name
Last Wt(r�� �� I First Lic. No. ,,���Class�.'
Contractor's Address
Contractor's E-mail Address
City l�
State Zip Telephoned, —�
OFFICE USE ONLY
6
PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.•.
OCCUPANCY - GROUP I j�y
, 6,7 I PLAN CHECK FEE $