HomeMy WebLinkAboutF2022-0637 - Permit ApplicationWorksheet for Fire Permit Application , / -1
Please print 3 copies \\
City of Newport Beach - Building Division �j lNJ I
Associated Building Permit # XG�2- ��'', (—•'•; Fire Sprinkler are Alarm r Fire Misc
1. Project Address (Not mailing address) � �Floorr Suite No
Tenant Name # Units 1 1
a•�
2. Description of Work
Use
Extg Sol Ft F—, New/Added Sq Ft Total Sq Ft � � 1 9
Valuation$
F_, New F-Add t�QP,lter (— Demo
# Stories
Check Appropriate Box for Applicant/Notification
3.Owner's Name
Last \ ^^ _ s
`l `it lC� CQ�1'1
Owner's Address
Owne
E-mail Address
City
- State F Zip F Telephoned—
F_ 4. Architect/Designer's
Name Last First �— Lic. No. �—
Architect/Designers Address
Architect/Designer's E-mail Address
City
State Zip F— Telephoned---
F_ 5. Engineer's Name
Last First Lic. No.
Engineer's Address
Engineer's E-mail Address
city
_. -
State F_ Zip Telephone—
-- - ------___ --.
. Contractor's Name
Last lt'/,.N.\pr-c _ First Lic. No.iss �.yC-( U
Contractor's Address
Contractor's E-mail Address
G
City State Zip _ q pz4b Telephone %1. -F-:
OFFICE USE ONLY
PERMIT NO. 2Lz_6Z,2 063 7
TYPE OF CONSTRUCTION PLAN CHECK NO. QC U221 — 31Z
OCCUPANCY - GROUP
(72 Z-(ZZ _ Z3 LAN CHECK FEE $