HomeMy WebLinkAboutF2021-0233 - Permit ApplicationPrint Form
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Associated Building Permit #
Worksheet for Fire Permit ApplicationO'Swm",City of Newport Beach - Building Division
D? Fire Sprinkler F_ Fire Alarm Fire Misc
1. Project Address (Not mailing address)
3&01 T#M&pEF R-D
Tenant Name I mteog/N CLE RNERS
2. Description of Work
REMJ'V E (B) Fr/2E sY'aaN/�c�uf
Extg Sq Ft �— New/Added Sq Ft r-- Total Sq Ft
F_ New F_ Add jR Alter F_ Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
#Units
Use
Valuation $ Soo. A
# Stories F
r 3. Owner's Name Last
�—
First F_
Owners Address
Owner's E-mail Address
City
State F--
Zip F Telephoner
4. Architect/Designer's Name
Last F First F_ Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City F
State
Zip F— Telephoner—
F_ 5. Engineer's Name Last
First— Lic. No.
Engineer's Address
Engineer's E-mail Address
'city
State W
Zip F— Telephoned
X6. Contractor's Name Last
(, l J7JW1j4_,A
First pV I Lic. No. 90 y3I5 Class CC-IIr
Contractor's Address
Contractor's E-mail Address _
0o.Bac3917
rz- /
City I Huu77w67thl ,36"
State G'A
Zip 92 /oa y` Telephone (71y)g y// -S� jL
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION)
e2 (
w
b%�i� PLAN CHECK NO.
OCCUPANCY -GROUP
V
PLAN CHECK FEE $
`kk DO(q l<0 d 120 -UU