HomeMy WebLinkAboutF2021-0197 - Permit ApplicationPrint Form
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Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Associated Building Permit tc>ac - z-1 2.7
17,- Fire Sprinkler [ Fire Alarm i- Fire Misc
1. Project Address (Not mailing address)
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Tenant Name
Floor Suite No
# Units
2. Description of Work
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Extg Sq Ft
New/Added Sq Ft Total Sq Ft
P New fl Add [ Alter P Demo
Use
OFF`rCE
Valuation $
# Stories
Check Appropriate Box for Applicant/Notification
F 3. Owner's Name Last
Owner's Address
p c o6 i-1 asPST - .4— First
E-mail
1
Address
(Owner's
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City
NE.,--,'P'�� 13C-ACLl State I
c A Zip I
ct 2 c 3 3 Telephone!
P 4.
Architect/Designer's
Architect/Designer's Name Last
Address
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First
Architect/Designer's
E-mail Address
Lic. No.
1
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City
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I c Zip
I er- 6 c_, Telephone
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P 5.
Engineer's
Engineer's Name Last
Address
First
Engineers
I
E-mail Address
Lic. No.
1
City
State
I Zip
Telephone
P 6. Contractor's Name Last
Contractor's Address
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First
Contractor's
1 1 Lic. No.
E-mail Address
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C- j
27S E• EL s S t .
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City
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1 Gd Zip
I 1 t o t rj Telephone
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OFFICE USE ONLY .PERMIT NO. VI(); `' el'll-
TYPE OF CONSTRUCTION )016/)1/4-001 PLAN CHECK NO �1 5 - V0 71
OCCUPANCY - GROUP
PLAN CHECK FEE $