HomeMy WebLinkAboutF2022-0383 - Permit ApplicationWorksheet for Fire Permit Application orEW�R>a
City of Newport Beach - Building Division
Please print 3 copies
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Associated Building Permit [Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
Tenant Name
2. Description of Work
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EMg Sq Ft New/Added Sq Ft '470q.q Total Sq Ft u CIC�9
❑v/New ❑ Add ❑ Alter ❑ Demo
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Floor Suite No
# Units D
Valuation$ W4$�
# Stories L " 1
❑ 3.Owner's Name Last First
Owners Address
Owner's E-mail Address
City _� State F
Zip F Telephone d
❑ 4. Architect/Designer's Name Last
First Lic. No.
Architect/Designers Address
Architect/Designers E-mail Address
City _ _ _ State �—
Zip Telephoned
5. Engineer's Name Last
First Lic. No.
Engineers Address
Engineers E-mail Address
City State
Zip C Telephoner'
W06. Contractor's NameLast j�Qgy ' First Lic. No. (�(� Class C-1�
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Contractors Address
Contractors E-mail Address
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city C�u^BYlA State
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Zip aZ$'�3 Telephone-
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OFFICE USE ONLY
PERMIT NO.2
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $