HomeMy WebLinkAboutF2021-0473 - Permit Applicationrint Form _ i
Please print 3 copies
Associated Building Permit#
Worksheet for Fire Permit Application
City of Newport Beach - Building Division r,J J 73
f2dAf F- Fire Sprinkler KFireAlarmF_ Fire Misc
1. Project Address (Not mailing address)
Tenant Name2/p.G
2. Description of Work T�
Extg Sq Ft � New/Added Sq Ft �— Total Sq Ft
t� New r Add T— Alter F_ Demo
VIICI. r� MFl Ill VFl11QLG uWA IVI AiJiJII,all U I\VUll VaII WIN
Floor Suite No
# Units i�-
5U
Valuation $
# Stories
r 3. Owner's Name Last
First
Owners Address
Owners E-mail Address
City � State I— Zip
F Telephone
r 4. Architect/Designer's Name Last
First F_ Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State FW Zip �w Telephoned
J— 5. Engineer's Name Last
First F Lic No.
Engineer's Address
Engineer's E-mail Address
� State �— Zip
� TelephoneF
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I� 6. Contractor's Name Last ��`7Zjp,(,(
First— Lic No. 1 8 Class
Contractor's Address
Contractors E-mail Address
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City C k%IC�✓%GP��IState Zip
ac Dqj Telephone lilt(
OFFICE USE ONLY
PERMIT NO.
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TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $