HomeMy WebLinkAboutX2021-2481 - Permit Application (3)Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit ❑ Fire Sprinkler ❑Fire Alarm l
Fire Misc
1. Project Address (Not mailing address) Floor
74OD_ —Y-CkV
Tenant Name
2. Description of Work
Exig Sq Ft 1 New/Added Sq Ft To Sq Ft
❑ New ❑ Add ❑ Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last— 1 F7777
Suite No
tii
# Units F
e -� fl v✓ih� a ti�l-"� _—�
Valuation $ G�
# Stories FT—Jl
Owner's Address Owner's E-mail Address
City 1 State �—� Zip F_—! Telephone—
❑4. Architect/Designer's Name Last _ _ —i First—, Lic. No. F—
ArchitectlDesigner's Address Architect/Designer's E-mail Address
I
City _ State F Zip TelephoneF—
❑ 5. Engineer's Name Last _ First 1
LicNo.
Engineer's Address Engineer's E-mail Address
I
City State Zip[__ Telephone�—
6. Contractor's Name Lastl� First- Lic.No. 7� Class
Contractor's Address Contractor's E-mail Address
City Isiah _ 8e7rhCtr f I'tv - State Zip r��'�j Telephone qj 117 50
OFFICE USE ONLY PERMIT NO. I l ✓
TYPE OF CONSTRUCTION �y ,� %� PLAN CHECK NO.
OCCUPANCY - GROUP PLAN CHECK FEE $