HomeMy WebLinkAboutF2022-0087 - Permit Applicationk- e ate- Worksheet for Fire Permit Application
Print Form 2 Z2 U 007 City of Newport Beach -Building Division
Please print 3 copies Q
Fire Sprinkler (- Fire Alarm i- Fire Misc
Associated Building Permit #
Floor Suite No
1. Project Address (Not mailing address)
# units �..®F-.-..®..
Tenant Name
2. Description of Work
Extg Sq Ft
New/Added Sq Ft � G' �, Total Sq Ft
New F Add F— Alter (— Demo
Check Appropriate Box for Applicant/Notification
Us 7 ZOO
Valuation $ �s
# Stories
r 3. Owner's Name Last First ) k_,_I,
Owner's Address Owners E-mail Address
4117 v OVA —
State Zip 9i�/ {�
City ��,7l5�'� Qe/) Telephone —
4. Architect/Designer's Name Last
First
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City
State F_ Zip F_ TelephoneF—
r 5. Engineer's Name Last
First Lic. No. F...—
Engineer's Address Engineer's E-mail Address
City State Zip Telephone)
f- 6. Contractor's Name Last �j Q� Firs' rrn' n c. No. �13��g3Class C 3 L
Contractors Address Contractor's E-mail Address 7
� / /.
City _.vi. State T/1- Zip 7,�?006 Telepi,
OFFICE USE ONLY
TYPE OF CONSTRUCTION —
OCCUPANCY-
ZesliZ - 00,� 5
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PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEE $