HomeMy WebLinkAboutF2023-0277 - Permit ApplicationPrint Form
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Associated Building Permit #
1. Project Address (Nol
Worksheet for Fire Permit Application ul�City of Newport Beach - Building Division
I apire Sprinkler F_ Fire Alarm F_ Fire Misc
,ess) I Floor Suite No
Tenant Name tMAW
i 9/ �`
2. Description of Work
Ii1S17� I11��� Ulf �� �iV� ��Y1�ILiky I�r'D .
Extg Sq Ft F_ New/Added Sq Ft F_
4 New j- Add r Alter r Demo
Check Appropriate Box for Applicant/Notification
# Units �—
Use
Valuation $
Total Sq Ft �—
# Stories F
F_ 3. Owner's Name Last t'% C i/ � j `
First) tlJl�
Owners Address
ff j j .y1 /)
k9d� V t t 6/ IU b
Owner's E-mail Address
City l
—� Zip V
State
d I FiTelephoneM• U 7511
r- 4. Arch itect/Designer's Name Last
t pIrII'1�
FirstLic. No
VJ
Architect/Designers Address
Architect/Designer's E-mail Address
City
State �— Zip [_ TelephoneF�
r 5. Engineer's Name Last
First F —Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City
State r-- Zip [_ Telephoned--
I— 6. Contractor's Name Last ZC I First OT-W— Lic. No. ��lv ' p
� Class
Contractor's Address WafrM �
Contractor's E-mail Address
City UG{ n�P
r79�--- r-7y-��—G�rn�s��e
State V 'it Zip I / d LX -1 Telephone ,u -q, 0.65 1
11 1 1 I V (l/ (JLr ( 1
r277
OFFICE USE ONLY
PERMIT NO. F 0?,7
TYPE OF CONSTRUCTION _
PLAN CHECK NO. _�Z' 3 _ I4O3
OCCUPANCY - GROUP
PLAN CHECK FEE $