HomeMy WebLinkAboutF2022-0136 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit #
1. Project Address (Not mailing
Tenant Name
2. Description of Work
rX Fire Sprinkler r. Fire Alarm ri Fire Misc
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Extg Sq Ft New/Added Sq Ft — Total Sq Ft F
[I New [ Add [Alter i— Demo
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Floor Suite No
# Units I/7
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Valuation $
# Stories
3.Owner's Name
Last _ First —
Owner's Address
— _
Owner's E-mail Address -
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cityState Zip r—! Telephone
�i 4. Architect/Designer's Name Last First �— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City - - -
State i Zip Telephone
[5.Engineer's Name
Last _ First— Lic. No.
Engineer's Address
Engineer's E-mail Address
city State �— ZiP I , Telephone
jf6. Contractors Name Last,./ First /y/Ci L2 Lic. No. Class—�
Contractor's Address
Contractor's E-mail Address
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city
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State State 04 Zip %(017o Telephone �9¢9
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OFFICE USE ONLY
r yr A PERMIT NO.
TYPE OF CONSTRUCTION
1, PLAN CHECK NO. _0co/7-�
OCCUPANCY -GROUP
h PLAN CHECK FEE $