HomeMy WebLinkAboutF2023-0597 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit #re Sprinkler Fire Alarm C- Fire Misc
1. Project Address (Not mailing addre
i DJe(, i-6,dV% 11 ,
Tenant Name
2. Description of Work
UVV, 0eA4 r/�r S}�ri�Kl� Sys f�r✓� t� 1
Extg Sq Ft New/Added Sq Ft Total Sq Ft (p�0
j_/New F- Add F_ Alter r Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units I
Use
Valuation $ �—
# Stories
(— 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City
State �� Zip F_ Telephoned
F_ 4. Architect/Designer's Name Last
First F_ Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State F_ Zip F— Telephoned--V—
F_ 5. Engineer's Name Last
First F Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City
State F_— Zip F— Telephoned-
F_ 6. Contractor's Name Last dt i First qt ) Lic No. j J �7�Class C to
Contractor's Address
Contractor's E-mail Address
� `Nq V
c u °e
City )'n�1\ r0 V i it
State G/ - Zip l 10 16 Telephone �Z�
OFFICE USE ONLY
012, `� PERMIT NO. -
TYPE OF CONSTRUCTION
08-sue PLAN CHECK NOJ - °t y
OCCUPANCY - GROUP
S ✓ PLAN CHECK FEE $
Cxitaco