HomeMy WebLinkAboutF2023-0263 - Permit ApplicationPrint Form Worksheet for Fire Permit Application
City of Newport Beach -Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
w �s y "
Tenant Name �'jLL' kjv+ 'eaaf, L �- L-
2. Description of Work
��--5 AU w
Extg Sq Ft 3 New/Added Sq Ft F
r New FX Add r Alter r Demo
Check Appropriate Box for Applicant/Notification
Total Sq Ft 6 7 2
Floor Suite No
I
# Units r
Use
Valuation $ F
# Stories F
r 3.Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City I
State F_ Zip
F_ Telephoned
r 4. Arch itect/Designer's Name
Last
First 7— Lic. No.I--
Architect/Designer s Address
Architect/Designer's E-mail Address +
City I
State F_ Zip
I�— Telephone
r 5. Engineer's Name Last
First F Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State Zip
F Telephoned
A6. Contractor's Name Last
First NGt(� Lic No. W,pZ% Class ) b
Contractor's Address
Contractor's E-mail Address
y
6 I/w�/� l✓t,�ti
-p
ur
cry Alect^b^t7u
ZiQ
State I C.i� p
Tele hone P{V e15
ID�L� p �al (0 3.}7 /
OFFICE USE ONLY
PERMIT NO. ZoZ3 " DZ 6 ,1
TYPE OF CONSTRUCTION
PLAN CHECK NO. a 3�
OCCUPANCY - GROUP
PLAN CHECK FEE $