HomeMy WebLinkAboutF2022-0086 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
1. rrolect Address (Not mailing
1107
Worksheet for Fire Permit Application �e""�R>
City of Newport Beach - Building Division (� � �
Fire Sprinkler r Fire Alarm r Fire Misc
Tenant Name I LOT CI ereACr 4 51 &>
2. Description of Work
RQ5-1Pe9T`lAL s'lme spe-iA ktet Sygr.+
Extg Sq Ft F New/Added Sq Ft
i— New j— Add Alter r Demo
Check Appropriate Box for Applicant/Notification
F 3. Owner's Name Last v5-rv*.I
Owner's Address
1Q1'1 RxPAW TEWC6
Total Sq Ft F
First I 19c6
Owner's E-mail Address
Floor Suite No
# Units F
Use
Valuation $ lc ZED —
# Stories F
City I COCC lA PELMAC State
Zip g2(oZ5 TelephoneF�
f 4. ArchitectlDesigner's Name Last I MtDTl%l l pESIG►1S First
Architect/Designees Address
1121e0 1Eul1.->fe ST
City I ►.I VatI
Lic. No.
Architect/Designees E-mail Address
State F Zip Q ,t� Telephone -714 -K L-442a
F 5. Engineer's Name Last I {Z106 First Fi,11p
Lic. No. Engineer's �—
Address
cEngineer's E-mail Address
23�tn �lovarey�oy� ve
city �c4+1+M11- State �G Zip 011; 1 Telephone j%
o-8Sc? ,.Y)L
F-6. Contractor's Name Last I RIOS First �y 117 Lic. No. IpgZell I Class (+ 1
Contractor's Address G11e V j
Contractor's E-mail Address U I
Z39"12 Ta�eri�w�a� plt
City �k e,,lllplt_ State I t/a — Zip g13Z % Telephone F818-$SO t nr &
rr _ Iw1f n
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
to�a�
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEE $