HomeMy WebLinkAboutF2022-0294 - Permit ApplicationWorksheet for Fire Permit Application 4
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit# rl Fire Sprinkler [iFire Alarm F_jFire Misc
1. Project Addresss� (Not mailing a dress) Floor Suite No
Tenant Name NyC #Units
2. Description of Work
..._Use =
0J
Extg Sq Ft ���/New/Added Sq Valuation $ryo� Ft �� Total Sq Ft �—! J
F_ New F_ Add I Alter F_ Demo # Stories F7
Check Appropriate Box for Applicant/Notification
Inforwntoon
3. Owner's Name
Last I First
Owners Address
Owner's E-mail Address -
I
City
_ I
State —j Zip- Telephone 1
[ 4. ArchitecVDesigner's Name Last _ _ I First � Lic. No. �—
Architect/Designer's Address
ArchitecUDesigners E-mail Address
—
City
---
State F Zip—, Telephone--
C5.Engineer's Name
Last FirstC Lic.No.
�—
Engineer's Address
Engineer's E-mail Address
City
_ State �- Zip TelephoneF77777
F_ 6. Contractor's Name Last
First Lic No. Class �6
Contractor's Address
Contractor's
�E-mailAddress
City _-..----------- State _I ` Zip /��7j / Telephone.—
OFFICE USE ONLY
PERMIT NO. 20Z Z ' O Z9 Y
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
P702V - 02