HomeMy WebLinkAboutF2023-0575 - Permit ApplicationWorksheet for Fire Permit Application of°�
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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# Units F
Tenant Name �--rVjp4S0d
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2. Description of Work
Use
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Valuations 'ao(+
Extg Sq Ft New/Added Sq Ft F_ Total Sq Ft �—
# Stories l O
TNew r Add r Alter F- Demo
Check Appropriate Box for Applicant/Notification
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F_ 3. Owner's Name Last
First F_
Owner's Address
Owner's E-mail Address
City State F—
Zip [— TelephoneF_
4. Arch itectlDesigner's Name Last
First �— Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City F State F—
Zip �— Telephone�—
5. Engineer's Name Last b2 i jS p M
First �, �� Lic No. F—
Engineer's Address
Engineer's E-mail Address
City Stater
Zip dab (� Telephone `> fU� . �)' 3 3 --(j
F-6. Contractor's Name Last FkTLIL-1 First S ,J,i,/ Lic No. Class
Contractor's Address
Contractor's E-mail Address
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City State �—
Zip Telephones//�� ,: _ -7 5
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PERMIT NO.
OFFICE USE ONLY
to PLAN CHECK NO:)C2-&
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP !
i'�� PLAN CHECK FEE $