HomeMy WebLinkAboutF2021-0029 - Permit Application.,rm Worksheet for Fire Permit Application
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print 3 copies City of Newport Beach - Building Division 1,a
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,ssociated Building Permit #
Fire Sprinkler r Fire Alarm i— Fire Misc
1. Project Address (Not mailing address)
� Floor Suite l� CCifflI & /v2. �Yan�
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Tenant Name
# Units F
2. Description of Work
Use
Extg Sq Ft ✓�— New/Added Sq Ft �— Valuation Total Sq Ft 7 f (yJ }j r7, ��
New F Add r Alter
F Demo #Stories 3
Check Appropriate Box for Applicant/Notification
F 3. Owner's Name Last �—
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Owner's Address First
Owner's E-mail Address
City
State r--- Zip
Telephonef__�
M 4. Architect/Designer's Name Last
ArchitecUDesigner's Address
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City ��cnYt
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f— S. Engineer's Name Last
First Lic. No. �7
ArchitecUDesigner's E-mail Address
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Zip `T/orb Telephone bA)37- �O�fjr
� First
Engineers Address Lic No.
Engineer's E-mail Address
City 1-- —
State F �— Zip TelephoneF —
F 6. Contractor's Name Last
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Contractor's Address First Lic No. rL9 2j�assr i
Contractor's E-mail Address J
City i �---_ F
State Zip
TelephoneF�
rOFFICE USE ONLY r
F CONSTRUCTION L�` '�L'C PERMIT NO. {
ANCY - GROUP % PLAN CHECK NO. t
��� �� 3b PLAN CHECK FEE $ —_�