HomeMy WebLinkAboutF2023-0370 - Permit ApplicationWorksheet for Fire Permit Application U
Print FormCity of Newport Beach -Building Division
Please print 3 copies ? 1 3
Associated Building Permit # Fire Sprinkler F_ Fire Alarm j-JFire Misc
1. Project AtAddress (Not mailing address) Floor Suite No
t� Zc
Tenant Name R c � k.p �� � f4 1 # Units F
2. Description of Work
Use
Valuation $
Extg Sq Ft F_New/Added Sq Ft �— Total Sq Ft F_ --- _-- - -
# Stories
I- New I- Add Alter F_Demo -----
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last I V-NV R kA La First r v
Owner's Address
Owner's E-mail Address
-too ✓ N,_�
. _
_ .
City
State I v'T Zip iP�o L Telephone
r 4. Architect/Designees Name Last
First! Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State 7— Zip F_ TelephoneF
5. Engineer's Name Last First F_ Lic. No.
Engineer's Address
Engineer's E-mail Address
City �—
State �- Zip Telephone�—
Intractor's Name Last ��FIVI Zk .� First be Lic. No. �(p']7� 3 Class��/
Contractor's Address
Contractor's E-mail Addres
City �VL�. I��Q� ---
State Zip UP-)1 Telephone � f_/_' J / 7V /7
OFFICE USE ONLY
PERMIT NO. a370
TYPE OF CONSTRUCTION
PLAN CHECK NO. ��
OCCUPANCY - GROUP
PLAN CHECK FEE $ l yak