HomeMy WebLinkAboutF2023-0464 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
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Please print 3 copies
Associated Building Permit # Fire Sprinkler F_ Fire Alarm r Fire Misc
1. Project Address (Not mailing address) / Floor Suite No
I a'S3-96C-+ c6A�Z'I0�,3 PEA ce, F_ F
Tenant Name
2. Description of Work
Extg Sq Ft F New/Added Sq Ft I —Total Sq Ft
1V,, New i- Add r Alter F_ Demo ✓ I Re/ d
Check Appropriate Box for Applicant/Notification (�
# Units F
Use
Valuation $
# Stories
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r— 3. Owner's Name Last �eG��
First
Owner's
Owner's E-mail Address
yAddress
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City N ���0(/r� b��ate I r '
Zip Telephonel—
Ci 4. Architect/Designer's Name Last First��. Lic. No. f r 'TUB
Architect/Designer's Address
Architect/Designer's E-mail Address
� q f'-ICE- &e � -� -
City [Jli/yl J✓ Z CGI jU !/date rc
Z i P qE-i-75 Telephone ��U ��` 1 -75
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F_5. Engineer's Name Last
First F Lic. No. F—
Engineer's Address
Engineer's E-mail Address
City I State F
Zip [_ Telephoned
(— 6. Contractor's Name Last �C'_I First �S �� Lic No. *IRS Class C-1(�
Contractor's Address
Contractor's E-mail Address
City 1 �J�`r I J u kl C'h/�� (1-a)Ngtate
Ki J� tC%
Zip ��7 , Telephon /� - (� `�
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OFFICE USE ONLY
PERMIT NO. WZ
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
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