HomeMy WebLinkAboutF2023-0037 - Permit ApplicationWorksheet for Fire Permit Application °°R�City of Newport Beach - Building Division (F'S1,
Please print 3 copies aap
Associated Building Permit#
F_ FireSprinkler [ Fire Alarm 7r-mire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name #Units
2. Description of Work
_ Use
EMg Sq Ft � � New/Added Sq Ft �—' Total Sq Ft F—! Valuation $
New F Add r Alter F_ Demo # Stories
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3. Owner's Name Last i
First F
OwnelIr's Address
Owner's E-mail Address
,\
-10_L-- _ �f��. 'U- - at, -- _ _ --- .. _ _.
CrtY State F—
Zip F—, Telephonef
4. Architect/Designer's Name LastI
First F_— Lic. No. F—
Architect/Designees Address
Architect/Designer's E-mail Address
City State �—
ZiP [777777 Telephoned--
F 5. Engineer's Name Last
-------.._.. --------._---
First
_ _ _ _ _ Lic No, F.
Engineer's Address
Engineer's E-mail Address
City - - _ - State —
Zip Telephone F
F 6. Contractor's Name Last . Ce First 1 n ��� Lic. No, SClass T_i 4
Contractor's Address
Contractor's E-mail Address
CitytVState
f J
Zip 6ry[S Telephone3OFFICE
USE ONLY
PERMIT NO. 0:jl
TYPE OF CONSTRUCTION w'
I•v
PLAN CHECK NO. �iG LOZ�j— Oi3L
OCCUPANCY - GROUP
PLAN CHECK FEE $
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