HomeMy WebLinkAboutF2023-0051 - Permit Application`W
Worksheet for Fire Permit Application p� `°"
City of Newport Beach - Building Division o '�
Please print 3 copies
Associated Building Permit #` Fire Sprinkler F—,Fire Alarm Fi fire Misc
1. Project Addres (Not mailin address) Floor Suite No
J-ev ue� .
i # Units �—
Tenant Name
2. Description of Work
_.-Use ---
.1 vtst �f F v^ i vl l��i°1A3 140
t - Extg Sq Ft 31 S �—
Valuation $ a
—" New/Added Sq Ft ___ �� Total Sq __
Ft
'---' __�_ �__�—�---'
# Stories
New [--- Add Alter F_ Demo '
Check Appropriate Box for ApplicanVNotification
(— 3. Owner's Name Last
First 7
Owner's Address
Owner's E-mail Address
City
State F_ Zip
7 Telephone
I— 4. Architect/Designer's Name
Last
First Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
1-77 - -------------
City
---- —
State Zip
----- - - - --- _ . -_ - _- -
�— Telephonei
d_
F_ 5. Engineer's Name Last
First Lic, No. F
Engineers Address
Engineer's E-mail Address
City
State- Zip
Telephoned
6. Contractor's Name Last
First r�,'y Lic No. lO 7M Class _c
Contractor's Address
Contractor's E-mail Address
City N i, V u l�q_
State ZA - Zip
-Q (G, Telephone O99 3- OCR
PERMIT NO. FZOU:�- _ CX:6 1
OFFICE USE ONLY
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $