HomeMy WebLinkAboutF2022-0503 - Permit ApplicationWorksheet for Fire Permit Application
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City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit #
ys
Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
I II Hoag fir.
Tenant Name I H D q /.i H oSP 14 a
Floor
# Units
Suite No
2. Description of Work
Are S V"1✓)KIQY' rv1Ovl I+ vvi
Extg Sq Ft I
UtG/4 l -k oii
.,2,w cla ✓i co;
New/Added Sq Ft I 1 Total Sq Ft I / -, es
❑ New ❑ Add ❑ Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
Infnrriatin
❑ 3. Owner's Name Last
Owner's Address
1
City I
-
❑ 4. Architect!Designer's Name Last
Architect/Designer's Address
City I
State I
Zip
First
Owner's E-mail Address
Use
I A3-g
Valuation $ II (pi 5.DO
# Stories
State
Zip
Telephone
First
Architect/Designer's E-mail Address
Lic. No.
❑ 5. Engineer's Name Last I
Engineer's Address
City
State I
II
Telephone)
First
Engineer's E-mail Address
Lic. No.l
Zip 1
Telephone)
176. Contractor's Name LastI Tit cG'/ 3�wIS FirstI
Contractor's E-mail Address
Contractor's Address
I cs9I mililken
City IArioht WCar'I vralq State I l
Lic. No. I c --7L.417Class
CIo
I wM6rr7S@triSyS .111c. cOriet
Zip I 61 ii g,c I Telephone)
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
PERMIT NO.
PLAN CHECK NO
PLAN CHECK FEE $