HomeMy WebLinkAboutF2022-0283 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # j Fire Sprinkler [ Fire Alarm [j Fire Misc
1. Project Address (Not mailing address)
Ave. 54=e*- ao�
Tenant Name
2. Description of Work
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Floor Suite No
4 Units
Use - -_ -
II�; Valuation $ �?00 QC
Extg Sq Ft j New/Added Sq Ft [ Total Sq Ft:, (--�
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fG- New [, Add [j Alter [ Demo # Stories
uneCK appropriate box for Applicant/Notification
[; 3.Owner's Name Last
First
Owner's Address��
Owner's E-mail Address
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City ew ''
State Zip Telephone
[ 4. Architect/Designer's Name Last
((�yu4 _ ; First Lic. No.�-
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
City
State Zip F_ Telephoner
5. Engineer's Name Last
First—
_ Lic No. �^
Engineer's Address
Engineer's E-mail Address
City
State Zip—; Telephone—
6. Contractor's Name Last First Lic No 4r _ Class F
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Contractor's Address
Contractor's E-mail Address
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State -4�--- Zip - - t'-�. 7 j-Telephone _- a-.._ 8.-7 '(fv,
OFFICE USE ONLY
PERMIT NO. vV
TYPE OF CONSTRUCTION
PLAN CHECK NO. I416' %0
OCCUPANCY -GROUP
PLAN CHECK FEE $
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