HomeMy WebLinkAboutF2023-0214 - Permit ApplicationWorksheet for Fire Permit Application �� '°"e
Print Form City of Newport Beach - Building Division o�' ";'F
Please print 3 copies "oa„.�
Associated Building Permit # Fire Sprinkler F_ Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
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Tenant Name
2. Description of Work
r �ifakl 1 0475
Extg Sq Ft � New/Added Sq Ft r— Total Sq Ft F_
r New r Add Alter r Demo
Check Appropriate Box for Applicant/Notif!cation
Floor Suite No
FM F v
# Units
Use V; —
Valuation
$
# Stories I
r3.Owner's Name
Last tl �v First—
Owner's Address
Owner's E-mail Address
e0-1 JAVP-
-oj r- - - -- - ---- -
City '�ik% j
State Zip I t/1 i elephoneF
r 4. Architect/Designer's
Name Last �— First Lic. No. �—
Architect/Designer's Address
Architect/Designees E-mail Address
City
- State Zip �— Telephone�—
I— 5. Engineer's Name
Last First I Lic. No. �—
Engineer's Address
Engineer's E-mail Address
— --
City
- --_------..._._- --...-------------_.-
State F_— Zip I— Telephone—
(- 6. Contractor's Name
Last First P jC. No. — Class �—
Contractor's Address
Contractor's E-mail Address
-
City f�yh`ct - - -. State Zip V'�/� Telephone �.I_ 3$�
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OFFICE USE ONLY
PERMIT NO. F20Z3- OZ�N
TYPE OF CONSTRUCTION
— PLAN CHECK NO. P�ZGZ;- I�BS
OCCUPANCY - GROUP
PLAN CHECK FEE $