HomeMy WebLinkAboutF2021-0258 - Permit Applicationp �-76 --z-v
Worksheet for Fire Permit Application o4'°
Print Form
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit#-� 1�(�D jFireSprinkler j Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name soz--r4 # Units
2. Description of Work
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Valuation $
Extg Sq Ft �� New/Added Sq Ft w Total Sq Ft
# Stories '
New j_ Add F Alter r Demo _
Check Appropriate Box for Applicant/Notification
r 3.Owner's Name
Last I jZ_,1L
First /�,
`Address
�
Owner's Address
Owner's E-mail
City
State �� Zip
F Telephoner--
F_ 4. Architect/Designer's
Name Last
First Fu Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State F_ Zip
F_ TelephoneF-
r 5. Engineer's Name
Last
First F_ Lic No. w
Engineer's Address
Engineer's E-mail Address
City
State F___ Zip
F- Telephoned
F_ 6. Contractor's Name
Last
b
First -- Lic No. i7y_945 Class
Contractor's Address
Contractor's E-mail Address
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City FlZi
State F_�;_ zip
I Rai Li C Telephone 7 ,q . alv?_ 7 �i(,
OFFICE USE ONLYo
PERMIT NO. FZ-� �- UL5; ��
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PLAN CHECK NO. I`7 / 00
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
PLAN CHECK FEE $