HomeMy WebLinkAboutF2023-0362 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler
1. Project Address (Not mailing address)
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Tenant Name
2. Description of Work
Fire Alarm ❑ Fire Misc
Tne.+, ( neo IQ PA 13D F-1we Sari, 1`411rl�v<fvj
Extg Sq Ft �— New/Added Sq Ft F Total Sq Ft F
New [ Add �' Alter [ Demo
Check Appropriate Box for Applicant/Notification
El 3. Owner's Name Last — First
Floor
# Units
Valuation $ _
Suite No
# Stories F,
7
Owner's Address Owners E-mail Address
I
i
CiTy State F—j Zip F Telephone 1
4.ArchitecVDesigner'sName Last _ _ FirstF Lic.No.�-
Architect/Designers Address Architect/Designer's E-mail Address
City State _ Zip F7777 Telephone-
F 5. Engineer's Name Last
First Lic No. 77
Engineers Address Engineer's E-mail Address
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City — — State _ Zip[— Telephone
F 6. Contractor's Name Last V I First Lic. No. ZS_S_2k' Class _�6
Contractors Address Contractor's E-mail Address
1539 ..LN.-- --. _Oe SCE,_ try L�v=_�c� _C r>'1
City 6LQY1d4c State C0 Zip o� q( Telephone�I� i� 2�66
OFFICE USE ONLY PERMIT NO. �%�j1�
TYPE OF CONSTRUCTION PLAN CHECK NO. I V
OCCUPANCY - GROUP !(�n ft�' fOr ` PLAN CHECK FEE $