HomeMy WebLinkAboutF2022-0333 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # J ❑ Fire Sprinkler ❑ Fire Alarm ❑ ire Misc
1. Project Address (Not mailing address) Floor Suite No
1-1,281� q2,q[ qz�_ s��r,Yz�-ralloj uWeo�, -DL F-1 0
rlEw P 7 '� SRcH 4 'L Uo 3
Tenant Name A/ #Units
2. Description of Work
CO °77ia�(s`�57 Uset—
l.VS7A�t_
Valuation $ 13 Z23
Extg Sq Ft r J /t/� / New/Added Sq Ft Total Sq Ft Z
�i � � I � 4 9/ # Stories El
�I New Add ❑ ❑ Alter ❑ Demo 0
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last t� W C PnA� Nov ((C First i p1G&
Owner's Address Owner's E-mail Address
�f0 (�Ctnlb io.✓ �}Y� J 7w 3oZ
City N6W YoaK State Zip 1 O n Z Z Telephone i�'__�-
❑ 4. Arch itect/Designer's Name Last First Lic. No.
Architec0esigner's Address Architect/Designees E-mail Address
City J State Zip Telephoned
❑ 5. Engineer's Name Last (o_ _ First 7 Lic. No.
Engineer's Address Engineer's E-mail Address
I
I
city � p �^ p Ci State Zip Telephone
❑I6. Contractor's Name Last ��I L_C� First E Lic. No. E4 (f ZOJ Class G
Contractor's Address Contractor's E-mail Address
g3ao �Vwrvrs- G er-11, L.4 felea �f C�rLnll 1_o(JfC DA`�W IA L�sS .Cav✓�
City S! ��� State l N' Zip C�z�) f� Telephone 8 518-y$ '
OFFICE USE ONLY L� ✓ —� PERMIT NO. ZOZZ- 0' 33
TYPE OF CONSTRUCTION / , ) PLAN CHECK NO. v
OCCUPANCY - GROUP l• 3 J ✓ PLAN CHECK FEE $