HomeMy WebLinkAboutF2023-0513 - Permit ApplicationWorksheet for Fire Permit Application Ure Print FormCity of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # J�Fire Sprinkler I— Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
—L(� IZ -Vt✓g' ✓�
Tenant Name ,t,;V_ I�
2. Description of Work
Extg Sq Ft I New/Added Sq Ft F— Total Sq Ft I —
New r— Add r Alter j— Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units F
Use
Valuation
# Stories FE
r 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City I
State F— Zip
TelephoneF�
F_ 4. Architect/Designer's Name
Last
First F_ Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State I Zip
F— Telephoner
r 5. Engineer's Name Last
First F Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City
State �— Zip
[_ Telephoner
(— 6. Contractor's Name Last [,D
First Lic No. 't j j,/U Class C—
Contractor's Address
Contractor's E-mail Address
City ��
StateF—W Zip
QI 5S 50 Telephone %leetij
OFFICE USE ONLY
PERMIT NO. O Q
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $