HomeMy WebLinkAboutF2022-0216 - Permit ApplicationPlease print 3 copies
Associated Building Permit#
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Te"Fire Sprinkler �; Fire Alarm Fire Misc
1. Prco�ject Adjdrress (Not mailing address)
Floor Suite No
/
Tenant Name
-
# Units �.
2. Description of Work
Use _
Valuation $
t'
Extg Sq Ft �� New/Added Sq Ft Total Sq Ft L3Zy� 0�I�
New
❑ Add [j Alter ❑ Demo
#Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last yv� c
'First TGq/`Y
Owner's Address
Owner's E-mail Address
63 o I//ti L,'clq Alor
City L% i State
7s�� I
�f _'.,� Zip _. 2 3 Telephone
FV4-.Architect/Designer'sName Last�Ih�cZ First �o� _ Lic.No. /D3,�PZ
Architect/Designees Address
Architect/Designer's E-mail Address �.
/2-.)- &-,� c�
— I h+ur�lh t / d h 9h�a GUM
_City c/i/74/1�-- _ State
_�'�--- ZiP- _/Q//1L_'Telephon (j-Z��jS-•-,f---
F_ 5. Engineer's Name Last _ First Lic. No.
Engineer's Address
Engineer's E-mail Address
City State-1
Zip Telephone—
[' 6. Contractor's Name Last
— —---
I First Lic No. [ — Class
--- - - --
Contractor's Address
Contractor's E-mail Address
City State
F Zip �— Telephoned
' n
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $