HomeMy WebLinkAboutF2023-0137 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division -0 131
Pc2-0zz-3191 F✓Fire Sprinkler F Fire Alarm F- Fire Misc
1. Project Address (Not mailing address) Floor Suite No
.30 SA74 MIqvE1.Tl�vlr�tsC1 3Fa�wjGra 9z�G0 F —1y 41o5
Tenant Name # Units �-
2. Description of Work
Use /IitO. ®FfcP
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KeleCo-ram I2 Fr2F_ 5pc,mKK(SE s, kAr,#.o$ jr-A.5�,is 4e5
Extg Sq Ft F— New/Added Sq Ft F Total Sq Ft
Valuation $ 15 dt70 `
/ Alter
r New F-Add
# Stories F
r✓ r Demo
Check Appropriate Box for ApplicantlNotification
I nfnrm o4inn
r 3.Owner's Name Last Rye pA5 17gYf lo(+r�I15.w7J First
Owner's Address
Owner's E-mail Address
/4131 AVoCtizPo kizwE
101
City f T{ EWyMT- STP6& Ia
State �- Zip jZCj L O TelephoneF
r 4. Architec esigner's Na Last
/2.Ob 1F.5 First f 6F_L: Lic. No. 7- 17G21
Architect/Designer's Address
Architect/Designer's E-mail Address
Ia 1S t%a�io c({T 2oao
A_Ro6le5 L CaSCe FaE•[.ol\
City PEAR
State C �, Zip Q2.$ZI Telephone 't,Y 989-146a
r 5. Engineer's Name Last
First Lic. No. 7
Engineer's Address
Engineer's E-mail Address
City
State Zip TelephoneF—
rv6 Contractor's Name Last CaSGe �rRE�Qv�'eeJaG� First— Lic. No. $�7-1 V ClassC-lio
Contractor's Address
Contractor's E-mail Address
1g�5 '1 aM�F 47 frp
�Mon1 @Ca.5_6F/A6-C.ait-,
City ���p�.
State �— Zip jZ j2,1 Telephone'(ry-Qsq-(,55
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. /22 egg�g _�
OCCUPANCY - GROUP
PLAN CHECK FEE $