HomeMy WebLinkAboutF2023-0222 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
fWPO
Worksheet for Fire Permit Application �`�
City of Newport Beach - Building Division n �g
av�'
r Fire Sprinkler F_ Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
&0 Be/ vices 4-rcle,
Tenant Name I —7CC. Sc; �c. 24 ZO
2. Description of Work
Extg Sq Ft F— New/Added Sq Ft F— Total Sq Ft
I— New r Add F_ Alter r Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units F
Use
Valuation $ % y vo'
# Stories
F 3.Owner's Name Last
First F_
Owner's Address
Owner's E-mail Address
City
State F_ Zip �— TelephoneF—
F 4. Architect/Designer's Name Last FirstF Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F— Zip F_ Telephoned
r 5. Engineer's Name Last 42
First `iY/ QrL Lic No. F—
Engineer's Address
Engineer's E-mail Address
141 oo ykwy
,Z z
City T'rrN
State ," Zip f Z�,Si Telephone%j'4-3J7-9Er�r
F 6. Contractor's Name Last �F7tx �/yc f� f , f FirstF—Lic No. 7?_ h-class C
Contractor's Address
Contractor's E-mail Address
Dior fi��N (�/r,rr
# IZ 2 /yI9rCGw.*f,,cF,�esys.��v
City r✓; h L
State e # Zip `% Z GIy Telephone 7y2
OFFICE USE ONLY
�j On� PERMIT NO.
TYPE OF CONSTRUCTION
�p �D° h PLAN CHECK NO.
r" �J
OCCUPANCY - GROUP
n��� PLAN CHECK FEE $