HomeMy WebLinkAboutF2023-0134 - Permit ApplicationWorksheet for Fire Permit Application o?EW��m
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City of Newport Beach -Building Division `- �(3 3' dl J o-
Please print 3 copies `'����""'"
Associated Building Permit # I— Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Sdoo I3�v'GLA Sf r lC
Tenant Name L.gf,,J�G�" /Lo # Units
2. Description of Work C� Ir
tti ,�t�,�YO (st-'L+n.c/il `� ( Use
Valuation $
Extg Sq Ft F_ New/Added Sq Ft F_ Total Sq Ft
# Stories
r New (— Add V Alter F_ Demo
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City �
State F_
Zip I— Telephoned--
j- 4. Architect/Designer's Name
Last
First— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_
Zip I Telephoners
r 5. Engineers Name Last
First F— Lic. No.
F
Engineer's Address
Engineer's E-mail Address
City
State �
Zip �— Telephoner —
I/ 6. Contractor's Name Last �SFirst �— Lic. No. Z343q� Class 16
Contractor's Address
Contractor's E-mail Address
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City �GjcI�a
State 214
Zip `127 Telephone 337—y67f
OFFICE USE ONLY
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A " Q PERMIT NO.
I, 0
TYPE OF CONSTRUCTION
,X`
PLAN CHECK N
OCCUPANCY - GROUP
lG&,02Z 0
3 011 PLAN CHECK FEE $
0 L� •�