HomeMy WebLinkAboutF2024-0017 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division Z3 o=
Please print 3 copies
Associated Building Permit #
Fire Sprinkler r Fire Alarm r Fire Misc
t. Project Address (Not mailing address)
Floor Suite No
3a-c�
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Tenant Name I
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# Units
2. Description of Work
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Use
Extg Sq Ft F
New/Added Sq Ft F—Total Sq Ft �—
Valuation $ J a00
# Stories F
F_ New
r Add IX Alter
j. r Demo
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name Last
First F
Owner's Address
Owner's E-mail Address
City
State F
Zip F_ TelephoneF—
i— 4. Architect[Designer's Name
Last
First Lic. No. �—
ArchitectlDesigner's Address
Architect/Designer's E-mail Address
City
State F__
Zip I — Telephoner
F_ 5. Engineer's Name Last
First F Lic No.
Engineer's Address
Engineer's E-mail Address
City �—
State F—
Zip F Telephone—
r 6. Contractor's Name Last
3u)
First Lic No. Class C —t
Contractor's Address
Contractor's E-mail Address
14, C-
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City S�—_
State FZ7Zip
i) --Tv(, Telephone �tdT )per_ I ttj
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OFFICE USE ONLY
�''�L7j.2l��J PERMIT NO. a
TYPE OF CONSTRUCTION
.� n
TZDom /" �L� �►sr� PLAN CHECK NO.
OCCUPANCY - GROUPj
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ni,,y� PLAN CHECK FEE $