HomeMy WebLinkAboutF2022-0260 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit#
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
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XFire Sprinkler ❑ Fire Alarm
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Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name # Units
2. Description of Work
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Extg Sq Ft New/Added Sq Ft �1 Total Sq Ft
Valuation $ ��.
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❑ New Add ❑Alter ❑Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name
Last I First
Owner's Address
Owner's E-mail Address
City
State F-71 Zip [7777 Telephoned
❑ 4. Architect/Designer's Name Last First E77777 Lic. No.
Architect/Designers Address
Architect/Designers E-mail Address
City
State Zip Telephone��
❑ 5. Engineer's Name
Last (�/LISSowt J First 54 Lic.No.�
Engineers Address
Engineer's E-mail Address
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State �i Zip Telephone y, S j
❑6.Contractor's Name Last f{rL! First Sr��/ J LicNo.F?7gf Class J6
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Contractor's Address
Contractors E-mail Address
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City tiT � _- State L I Zip ' Telephone 71l(_ 9p _75 L
OFFICE USE ONLY
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TYPE OF CONSTRUCTION
PLAN CHECK NO. (33� — ZerliZ
OCCUPANCY - GROUP
PLAN CHECK FEE $