HomeMy WebLinkAboutF2023-0007 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # • F_ Fire Sprinkler I—; Fire Alarm ri Fire Misc
1. Project Address (No addres
Floor Suite No
/mJ(a'il'ng
------ . -- —
/
Tenant Name
' A& !
# Units
2. Description of Work
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C� Cic-1 i��' � (ct� _,
Use
Valuation$ aSJ
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Extg Sq Ft New/Added Sq Ft Total Sq Ft -i
# Stories
New F_ Add F;
Alter I— Demo
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name
Last First—,
Own�er'sy Address
Owner's E-mail Address
City - _ -
_ State �, Zip vl� v Telephone[
F_ 4. Architec9 Designer's Name
Last First �— Lic. No.I —
Architect/Desi ner's Address
Archite ct/Designer'a E- it Address
City
_ _ _ - State I Zip F— Telephoned----
F_ 5. Engineer's Name
Last First Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City
State Zip Telephoned------
r'6.Contractor's Name Last
��/� First �]r} Lic No. Class
Coonttra_ctor's Address
Contractor's E-mail Address
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city LC1( 3
State zipF�
- / "6 -Telephone 3Z q —/'�-
OFFICE USE ONLY
• r PERMIT NO. ��%O L3• b�'l
TYPE OF CONSTRUCTION
�� l PLAN CHECK NO. ��'��%� VOW
OCCUPANCY - GROUP
I /'y� PLAN CHECK FEE $
10.0000 (.,11t