HomeMy WebLinkAboutF2022-0386 - Permit ApplicationWorksheet for Fire Permit Application
Prip{ Form,.;: City of Newport Beach - Building Division
Please print 3 copies �Sj ��i/� ��(Y" oar•
Associated Building Permit# �('ZO2Z—\5,+64 ❑ Fire Sprinkler ZFireAlarm ❑FireMisc
1. Project Address (Not mailing
"address) Floor Suite No �
Tenant Name G UhAE 5 # Units
2. Description of Work
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Extg Sci Ft I J New/Added Sq Ft Total Sq Ft
use
Valuation$ 1(5
' 6
❑ New ❑Add '0 Alter ❑Demo # Stories
Check Appropriate Box for Applicant/Notification `
❑ 3.Owner's Name
Last \t(� �V�A C6yy�p�y �First177-71
Owner's Address
Owner's E-mail Address
City
State I.I Zip Telephoned
❑ 4. Arch itect/Designer's Name Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �� Zip � Telephoned
❑ 5. Engineer's Name
Last First F777-71 Lic. No.
Engineer's Address
Engineer's E-mail Address
City
I
State !� Zip L, Telephoned
❑ 6. Contractor's Name Last
First Lic No. ���� Class Gl O
d
Contractor's Address
Contractor's E-mail Address
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0`'`i iSY C� 1�C t nc , ✓t u
City C Uy State Zip Gj 15� Telephone
OFFICE USE ONLY
PERMIT NO. _GZOZZ"d3��
TYPE OF CONSTRUCTION
PLAN CHECK NO. 45
OCCUPANCY - GROUP
PLAN CHECK FEE $