HomeMy WebLinkAboutF2022-0085 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
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Please print 3 copies `L06
Associated Building �1
9 Permit# �.�Q�%- t -'! (-; Fire Sprinkler r�DFire Alarm ri Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name C���-� x� # Units L 1
2. Description of Work
�T(C1c),Use PF i /-N --- j
Valuation$
Extg Sq Ft F_ — --- New/Added Sq Ft j Total Sq Ft �31 1 -- ---- - ---
(-1 New r Add M Alter ❑Demo #Stories
Check Appropriate Box for ApplicanVNotification 111
L.F.. ..�:..
I_ 3. Owner's Name
Last First
Owner's Address
Owner's E-mail Address
city �—
State Zip 777
[; 4. Architect/Designer's Name Last First—Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State—' Zip Telephone
r; 5. Engineer's Name
Last First
-� - I F Lic. No.I
Engineer's Address
r
En 'nee 's E-mail Address
- - - ---
City
State —! Zi Telephoned,
6. Contractor's Name Last �(J�y`i�( First Lic. No. � _ L�j Class C ( O
Contractor's Address
Contractor's E-mail Address
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% e, _ 10P L rvc. v 'v
City �C l ten. l S� v
_-- State Zip �J1 j Telephone i)
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
71
/11 PLAN CHECK
OCCUPANCY- GROUP
00
PLAN CHECK FEE $