HomeMy WebLinkAboutF2023-0407 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # F_ Fire Sprinkler K Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
C' d AAWY&�F C��0- >7F__
Tenant Name I `i
2. Description of Work
Extg Sq Ft F_ New/Added Sq Ft Total Sq Ft
F_ New I- Add [_ Alter j- Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
I �'` F
# Units I
Use
Valuation $ F4v7
# Stories PT
r 3. Owner's Name Last j; -jz y y7; �F,�tjrirst F_
II
Owner's Address
Owner's E-mail Address
I�
City iJi �C% L�'F� State F 61F Zip
9` (A Telephone
1
i- 4. Architect/Designer's Name Last
First F__ Lic No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F___ Zip F__ Telephone—
r 5. Engineer's Name Last '�T �I G
First � /G� Lic No.
177�9`
Engineer's Address
Engineers E-mail Address
/
%� 6 �fn%b5Al
City �(� State I ' Zip
1 (J Telephone qQl.-(%�
r 6. Contractor's Name Last `p Pj� rJT,4CM //✓W
I
First F Lic No. I Class F—
Contractor's Address
Contractors E-mail Address
City I State [-- Zip
F— TelephoneF_
OFFICE USE ONLY
PERMIT NO. V ul)/-
TYPE OF CONSTRUCTION
PLAN CHECK NO. Ivu a
OCCUPANCY - GROUP
PLAN CHECK FEE $