HomeMy WebLinkAboutX2021-1718 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
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Please print 3 copies
Associated Building Permit# I XlFireSprinklerF-: Fire Alarm -, Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
Tenant Name #Units
2. Description of Work
Use
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Valuation $ Fe, ;a; �o
Extg Sq Ft New/Added Sq Ft Total Total Sq Ft �—
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New F_ Add � Alter � Demo
# Stories I _
Check Appropriate Box for Applicant/Notification
[-; 3.Owner's Name
Last First �—
Owner's Address
Owner's E-mail Address
City
State F-- Zip F-- Telephoned
F_ 4. Architect/Designer's
Name Last FirstF_Lic. No. -
Architect/Designer's Address
Architect/Designees E-mail Address
City
State'- - _. Zip Telephone—
(- 5. Engineer's Name
Last First Lic No. �—
Engineer's Address
Engineer's E-mail Address
I
city
State F_ Zip F TelephoneF—
L 6. Contractor's Name
Last %KdAA First /yl%4 Lic. No. F, 7q//r class e---14
Contractor's Address
Contractor's E-mail Address
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City -/I`io Vi`GIO - -. State A Zip 9ij&,'(& Telephone rf4f ./I99�
OFFICE USE ONLY
'-- PERMIT NO. - 171`i5
TYPE OF CONSTRUCTION O PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $