HomeMy WebLinkAboutF2022-0284 - Permit ApplicationWorksheet for Fire Permit Application
Please print 3 copies City of Newport Beach - Building Division ° m
Associated Building Permit # � �(� [,-,,Fire Sprinkler F J Fire Alarm j Fire Misc
1. Project Address (Not mailing address)
Tenant Name
2. Description of Work -- ------ —.J
T. a-
EMg Sq Ft � , I Ll t;New/Added Sq Ft
Sq Ft
❑ New [ Add Vj Alter
r.Demo
Check Appropriate Box for Applicant/NotificatioIn 4
❑ 3.Owner's Name Last
Owner's Address --�
City--�
State i
First 1777
Floor
e Suite No
LZ
# Units 177
Valuation $ �L .lam
# Stories
Owner's E-mail Address
Zip Telephone ----I
4. Architect/Designer's Name Last --
Architect/Designer's Address — _—__I First �—
Lic.No.
City �—
Er 5. Engineer's Name
Lic. No. L
Engineer's E-mail Address L
Zip ---Telephone-- -- -----
L 6. Contractor's Name Last UV -6v I- First -
_._._... --------- / n � ,
Contractor's Address - jy br l Lic. No. 4`5g1X1 Class
Contractor's E-mail Address
city --atn.,re,w�zY�er$ -c >
C SI 6 VtG1 --- State ' ��—� W1_
-- --_ /Gi Zip P
- 1 .----Tele hone (PZG2 4i -
-- S� t�Z3
OFFICE USE ONLY --
TYPE OF CONSTRUCTION PERMIT NO. GuZZ_ 62b
OCCUPANCY - GROUP A p PLAN CHECK NO.
020
� 1 g� Z�ZZ
02072-618i PLAN CHECK FEE $�_
Architect/Designer's E-mail Address _
Zip Telephone
Last J
First
Engineels Address — —
City
— ---_ State
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