HomeMy WebLinkAboutF2022-0104 - Permit Applicationqo Worksheet for Fire Permit Application
Print Form �7yt�" C3 City of Newport Beach - Building Division - p\b�
Please print 3 copies (95 `i 6-2-O ZZ FU7,-Z - 0(0N
Associated Building Permit # Z 0) 6) - 3 r Fire Sprinkler Fire Alarm j- Fire Misc
1. Project Address (Not mailing address) Floor Suite No
)244 YIMO]e Pf, C2 t)/ 4)2- r 6fW Z1 l , rig 9zF F_
Z(t) Cr " Df
Tenant Name # Units F
2. Description
>of Work
Use
Valuation $ jJQ�cW
Extg Sq Ft F_New/Added Sq Ft Total Sq Ft �®
# Stories
jV"New (- Add r Alter j- Demo
Check Appropriate Box for Applicant/Notification
r 3.Owner's Name Last First
Owner's Address Owner's E-mail Address
City State F Zip F— Telephone
r 4. ArchitectlDesigner's Name Last First F Lic. No.
Architect/Designer's Address Architect/Designees E-mail Address
City I State Zip [_ Telephone F_
I® 5. Engineer's Name Last®-� First �® Lic. No.
Engineers Address Engineer's E-mail Address
City State Zip F— Telephoned
Fe 6. Contractor's Name Last First x)� Lic. No. �Dq� Class C-)
Contractor's Address Contractor's E-mail Address
City ) �% /) State C p7 Zip 9Z �ry Telephone r - 7zs)- �Oog
OFFICE USE ONLY PERMIT NO. 2022'OI d f
TYPE OF CONSTRUCTION PLAN CHECK NO. 0546 fZPZZ
OCCUPANCY - GROUP PLAN CHECK FEE $