HomeMy WebLinkAboutF2021-0578 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
3021 - oS
Plep
Associated Building Permit 4 I r Fire Sprinkler ' Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name �` �ct� `, �e..c'C�o #Units
2. Description of Work1
\ �—• e�, 1g3 gNtF Use ...R
Valuation$ DLJO
Extg Sq Ft New/Added Sq Ft Total Sci Ft -- _
\/ #Stories 3
r New F- Add p� Alter j ' Demo
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
First
Owners Address
Owner's E-mail Address
City State F_:__ Zip
F_ Telephone---
I—i4.ArchitecNDesigner'sName Last(
First F Uc.No.
Architect/Deslgner's Address
Archdect/Designer's E-mail Address
City _ - State F77 Zip
-- TelephoneF
["! 5. Engineer's Name Last
j First Lic. No.
Engineer's Address
Engineer's E-mail Address
city State Zip
L Telephone---
Contractor's Last �6.�
First Lic.No. (,1L\53; Class ,: \C
Contractor's Address
Contractor's E-mail Address
State -
Cityr Zip
11�±._ P
- hone
Tele �'I�- P 1�Cloi_ C�bOIJ
-
kZA
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION k(� 0635
PLAN CHECKNO. Z bL�� ' ZOZ'
OCCUPANCY - GROUP
PLAN CHECK FEE$ 5/ !74*75
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