HomeMy WebLinkAboutF2022-0494 - Permit ApplicationPrint Form Worksheet for Fire Permit Application ` lfq
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City of Newport Beach -Building Division
Please print 3 copies
Associated Building Permit #
rY Fire Sprinkler [_ Fire Alarm j— Fire Misc
1. Project Address (Not mailing address) Floor Suite No
5U SANDcrtSTl E U,z C01ot-A DC-(, rnfiQ CfZ615 [
#Units
Tenant Name
2. Description of Work
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Use
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Extg Sq Ft 215& New/Added Sq Ft FT4-7 Total Sq Ft Z,j 65,
Valuation $ -z,-5 o
# Stories r
New r Add f- Alter (' Demo
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City F_
State F_
Zip F Telephoned
(_ 4. Architect/Designer's Name
Last
First -- Lic. No.��
ArchitecUDesigner's Address
E-mail Address
(Arch�itecUDesigner's
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City F
State F_
Zip [_ Telephonel�
Fv- 5. Engineer's Name Last
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First I C r/)qD Lic.No. 5(bV7
Engineer's Address
E-mail Address
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Engineer's
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City I1E+C)o"Do 13C-/ICN
State ('(.�
Zip S-Oz7)- Telephone ?Si_75e-T2(oj
F� 46. Contractor's Name Last
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First ry�gVC Lic No. rj(P (q C/�g ClassrC'/(
Contractor's Address
Contractors E-mail Address
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City RC->7oN� f3c C/y
State ��
Zip cjoe76_ Telephoner2f � 605 4t7il
OFFICE USE ONLY
PERMIT NO. FZUZZ-0�gll
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $