HomeMy WebLinkAboutF2023-0098 - Permit ApplicationWorksheet for Fire Permit Application J
City of Newport Beach - Building Division r Wo -boy0
Please print 3 copies
Associated Building Permit # �j Fire Sprinkler Fire Alarm �. Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name C1i�C�' '-r��.C-,n-4z .-. _. ';_ #Units
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2. Description of Work
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EMg Sq Ft New/Added Sq Ft Total Sq Ft + r 20--
Valuation $ 04
[� New � Add �'t Alter j-j Demo
# Stories
Check Appropriate Box for Applicant/Notification
F_, 3. Owner's Name
Last +t V� y� Q 1 First ,
1
Owner's Address
Owner's E-mail Address -
City
State �- Zip Telephone
4. Architect/Designer's Name Last �- First— Lic. No. F—
Architect/Designees Address
Architect/Designer's E-mail Address
City
State Zip Telephoner_----
5. Engineer's Name
Last First- Lic No. --
Engineers Address
Engineer's E-mail Address
City
State r-- Zip Telephoners
F_ 6. Contractor's Name Last
�j,161� First 'E-'tu/koCa LicNo.
N, Class
Co-nttracctor's Address
Contractor's E-mail Address
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City F-
___.. State �— Zip..�I�c�.�Telephone /y�(`,�---7J�S-...,,.
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. �G'Lf7�3 OOCIIV
OCCUPANCY - GROUP
PLAN CHECK FEE $