HomeMy WebLinkAboutF2022-0511 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division ran^ /, ,1
Please print 3 copies v�
Associated Building Permit# Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
1'� IV110n J/npr-
Tenant Name N L` h Uc r-1,ed G oad S
2. Description of Work
Extg Sq Ft New/Added Sq Ft _I Total Sq Ft
❑ New ❑�1dd ❑ Alter ❑ Demo
,.necK mppropnate MOO Tor Applicantmotitication
U
Floor Suite No
I--
# Units
Use S_
Valuation $ 'L 1�UO�
# Stories I i
S+ 2
❑ 3. Owner's Name Last �TJ��N� `er.�p First
Owner's Address Owner's E-mail Address
106 (nvkeVA-�:Zr• `)
City �fV\'1cL _ State Zip Telephone[
4. Arch itect/Designer's Name Last GrpUL First 'Da„�; K,l Lic. No. 1-5,aq Z
Architect0esi/gner's Address A
rchitect/Designe
r's E-mail Address
IL{'"i-% C� i'`"W ..I� �e�• G�G'F�f`�raTit ti�'i J1.. �e�, L.w
I
City ti(�.( �7� G.� y State Gk J Zip Telephone iy) 3 d I Ol y
5. Engineer's Name Last First F_7�11
Lic No. F-;
I
Engineer's Address Engineer's E-mail Address
I
City _ State ��' Zip F—; Telephoned j
6. Contractor's Name Last 61
! First {]�v� Lic. No. Class
Contractor's Address Contractor's E-mail Address
I417-72, ar r— Sf, trr ro{rc+' �,(P_ , cB•-,
- --
City Mrolw G� — State G4 ZIP �s'JC Telephone t4735eT014j
OFFICE USE ONLY PERMIT NO. I OS
TYPE OF CONSTRUCTION XZ�`Z l 3 Gt y PLAN CHECK NO. 26
OCCUPANCY - GROUP t 7
PLAN CHECK FEE $