HomeMy WebLinkAboutF2022-0613 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
�V n 11-
Associated Building Permit # F Fire Sprinkler Fire Alarm (— Fire Misc
1. Project Address (Not mailing address)
N LA
Floor
Suite No
# Unitsj
Tenant Name I i
2. Description of Work prkom,:
Use- -- ---
__
Valuation $
Extg Sq Ft New/Added Sq Ft Total Sq Ft - -
# Stories
F_ New F(Add F7 Alter (— Demo l
Check Appropriate Box for Applicant/Notification
j— 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City !
State Zip Zip
Telephone
F_ 4. Architect/Designer's Name Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip ` Telephoned`
F_ 5. Engineer's Name Last I
First Lic. No. F�
Engineer's Address
i
Engineer's E-mail Address
City
State Zip
777 Telephone
F 6. Contractor's Name Last
First V, Lic. No. �� z/lS Class
............... ._ -- - - -
Contractor's Address
Contractor's E-mail Address
I -Mark C 48 -tr010,E Ms
City /-lp ,
State Zip
f -1� Telephone 7/ �{.I �jQ
OFFICE USE ONLY
PERMIT NO. � ' 00!�
TYPE
PLAN CHECK NO.�'��'y�I�I
OF CONSTRUCTION
OCCUPANCY - GROUP
PLAN CHECK FEE $