HomeMy WebLinkAboutF2021-0290 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # F_ Fire Sprinkler J_ Fire Alarm Fire Misc
1. Project Address (Not mailing address)
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Tenant Name 4 '" 0y,_ y As-s-L.S'"f,Z ^91 LW
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2. Description of Work
Extg Sq Ft F—'. New/Added Sq Ft F_. Total Sq Ft F_
j/New r Add r Alter (— Demo
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Floor Suite No
# Units
Use
Valuation $ �� Q
# Stories F
F_ 3.Owner's Name
Last
---'
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Owner's Address
Owner's
er's E-mail Address
City I
leState
_.. Telephoned
—. Zip F_
F_ 4. Arch itect/Designer's Name Last
First r-- Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State
f -- Zip F--, Telephoned.
6. Engineer's Name
Last
First F L ic. No.
Engineer's Address
Engineer's E-mail Address
City
State
Zip--., Telephone
( 6. Contractor's Name Last I V d First S�-V-e� Lic. No. 7o f Class --
Contractor's Address
Contractor's E-mail Address
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A n
City +P- tel
State
F �_ Zip ��� Telephone j�} • 'Zrj1 _q l <( t�
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $
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