HomeMy WebLinkAboutF2022-0152 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler [ Fire Alarm [-i Fire Misc
1. Project Address
Tenant Name Lt1 )9 In
2. Description of Work
address) Floor Suite No
TUN
,� V I Units F
Exig Sq Ft 1, New/Added Sq Ft1 Total Sq Ft —�
New [ Add [Alter Demo
Check Appropriate Box for Applicant/Notification
Valuation $ (l�lli
# Stories
3. Owner's Name Last �� lam_ First
Owner's Address
Owner's E-mail Address
i
City
State Zip Telephone
4. Architect/Designer's Name Last First Lic. No.
—
Architect/Designees Address
Architect/Designers E-mail Address
-- --
City
-r— - -- -- -.. --.-. - - 1
State I Zip Telephoned—,
[5.Engineer's Name Last _— FirstC Lic. No.7—I
Engineer's Address
Engineer's E-mail Address
City
-----------
State F_ Zip �—� Telephone—
. Contractor's Nam Last
�h� - First Lic. No. _i� 1 qqq]
_ 1
Contractors Address
Contractor's E-mail Address
]�
CiTy 1 D %� —
—ONLY
State �— Zip � Telephone R V U3 614
OFFICE USE
y M PERMIT NO. �!�*� Liz
TYPE OF CONSTRUCTION
— •� , ! PLAN CHECK NO.
OCCUPANCY - GROUPF,
PLAN CHECK FEE $
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