HomeMy WebLinkAboutF2022-0634 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division y p63y
Please print 3 copies `�
Associated Building Permit#
1. Project Address (Not mailing address)
Tenant Name Ula�
2. Description of Work
Fire Sprinkler r Fire Alarm r Fire Misc
Floor Suite No
F.LIJ�V_-
# Units I
2-1 Qft,11 r !�qnvl"'d. use 0� .
Valuation / �^
Extg Sq Ft New/Added Sq FtT7777 Total Sq Ft �� /� -�-
r New r Add Alter (- Demo # Stories I r-
1
Check Appropriate Box for Applicant/Notification I j
3. Owner's Name Last/ First
Owners Address
V Owner's E-mail Address
City W n 1,.
State—, Zip iX ielephone[7
F_ 4. Architect/Designer's Name Last
�ml �l v t First' 4 r L Lic. No. 3`LL
IJI
Architect/Designers Address
Ar hitect//D�esigne/�r's/�E�-mail Address
�q
CJ/
�-�,,, °
City i ` ��Q /
-
State i�- Zip 1Q Telephone
r 5. Engineer's Name Last
J I �� { Lic. No.
EngineersAddress
Engineer's E-mail Address
' ` ^
w `
City
Stag Zip FW Telephone
r 6. Contractor's Name Last ` First �� Lic. No. Class
_
Contractor's A dress
Contractors E-mail Address
-
I�Lb It U� �G�✓t
City RYW -.
State �— Zip s Telephone jut 36)4t
OFFICE USE ONLY
PERMIT NO. ?I' Z ��
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $