HomeMy WebLinkAboutF2023-0290 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
1. Project Address (Not mailing address)
23 2 -2-
Tenant Name
2. Descrintion of Wnrk
ilY 2 ✓ S l�
Extg Sri Ft �— New/Added Sq Ft
( New r Add r Alter r Demo
F�Fire Sprinkler r Fire Alarm r Fire Misc
�rrGarc mijpropnate Isox ror Applicant/Notification
Floor Suite No
It Units F
Use
Valuation $ /��•�o
# Stories 3
r 3. Owner's Name Last
First 7—
Owner's Address
Owner's E-mail Address
City I
State �—
Zip F Telephoner—
F_ 4. Architect/Designer's Name
Last First I— Lic. No. I —
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �—
Zip [ Telephone—
r 5. Engineer's Name Last
First Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City I
State �—
Zip F— TelephoneF_
K6.=Contractor's Last
m
J
First 1 fCl�Lic No. Fop�c)l Class C-
Contractor's E-mail Address
giZC( 5k�1\q✓ C�•
City l lX t� G
i' /�
State FEW
Zip i383 Telephone O�i`j j -(p
C�
OFFICE USE ONLY-�
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $