HomeMy WebLinkAboutF2021-0048 - Permit ApplicationWorksheet for Fire Permit Application
Please print 3 copies
City of Newport Beach - Building Division z4
a
a
Associated Building Permit # nnIder Fire S
_ _ ❑ P � )�j Fire Alarm (—_; Fire Misc
1. Project Address (Not mailing address)
G: Floor Suite No
Tenant Name
_-- __ --- # Units
2. Description of Work
b -.� Use
�—
EMg Sq Fdd Valuation t NewlAdded Sq Ft F Total Sq Ft
(- New F_ Add j Alter F_ Demo # Stories
Check Appropriate Box for ApplicantiNotification
F_ 3. Owner's Name
O—wner's Address
(p 2-0
City
Last I First
j Owner's E-mail Address
F_ 4. ArchitecUDesignees Name
Architect/Designees Address
City
bR �t5p
-- ---- —
stateFTF_ - ZIP r J Telephone�—
Last First Lic. No. �—
Architect/Designer's E-mail Address
sta
�� ZIP TelephoneF—
S. Engineer's Name Last/ � First i Fi ���a
--- -- {- -- --- - -- — I t - "' L� __; Lic No.
Engineers Address Engineers E-mail Address
City State ZiP Tel hone
-- - _
�' 6. Contractors Name Last
d� gall HIA*fi rst �— Lic No. Class �—
Contractors Address Contractors E-mail Address
City
state �- ZiP Telephone—.
OFFICE USE ONLY PERMIT NO. F ZOU - Dv4 a
TYPE OF CONSTRUCTION PLAN CHECK N0. i:-�l `LDZI
OCCUPANCY -GROUP wv4 }.fp PLAN CHECK FEE $ 1114.1