HomeMy WebLinkAboutF2023-0315 - Permit ApplicationWorksheet for Fire Permit Application�� � II 40"Rg
Print Form City of Newport Beach - Building Division ► �zX� I (� }� Please print 3 copies LQUJZ
Associated Building Permit # Fire Sprinkler 1- Fire Alarm I- Fire Misc
1. Project Address (Not
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)MIOC SEA
Tenant Name
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2. Description of Work
Extg Sq Ft F New/Added Sq Ft Total Sq Ft
1- New r- Add r- Alter 1- Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
# Units �—
Use
Valuation
/ �c7
# Stories
r— 3. Owner's Name Last ��
' First F—
Owner's Address
Owner's E-mail Address
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SSA
City I �j � n
State �— Zip F Telephone
r- 4. Architect/Designer's Name
Last First �— Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �— Zip F— Telephone—
r- 5. Engineer's Name Last
First 7 Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City �—
State F_ Zip F— Telephone
F_ 6. CC/oontracts Last 6(9vl� c-_Z U
First .�Ku_oG Lic -7 No. i 1179 class L`-i&
!Name
ContractOr's Address��
Contractor's E-mail Address
City %�d(/ s / r/n
State Zip C) Telephone "� (Pp ,- `7Z 2JL 75..
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OFFICE USE ONLY
PERMIT NO. Z 0 y
TYPE OF CONSTRUCTION
�� 3 U�'� PLAN CHECK NO.
OCCUPANCY - GROUP
J Ly PLAN CHECK FEE $