HomeMy WebLinkAboutF2024-0068 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit # F_
1. Project Address (Not mailing
Tenant Name
2. Description of Work
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Sprinkler r Fire Alarm r Fire Misc
Floor
Suite No
It Units
F—
Use
�,e_& ds
Valuation $ iZ) o v
Extg Sq Ft F New/Added Sq Ft F— Total Sq Ft F
It Stories F
r New r Add r Alter I— Demo
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name Last �t�rl
First 5A
Owner's Address
Owner's E-mail Address
City � State �` Zip
�— TelephoneF_
First— Lic. No. F
F- 4. Architect/Designer's Name Last
ArchitectlDesigner's Address
Architect/Designees E-mail Address
City State
�— Zip
F_ TelephoneF_
r 5. Engineer's Name Last
First— Lic No.
Engineer's Address
Engineer's E-mail Address
City State
�— Zip
�— TelephoneF_
6. Contractor's Name Last srt
First jt,,lgr d Lic. No. 7/ jjT9 Class[C- 16
vaoFo
Contractor's Address
Contractor's E-mail Address
`2-U-7 LG +I�.crfi 1_
1 01 r 0.listui 9vt.H:i LO'�'
city State
CQ Zip
�ZCfSc� Telephone 3c)I-6m-7-6161
OFFICE USE ONLY `�
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t�7 PERMIT NO�yLMI'" LSD �R
TYPE OF CONSTRUCTION NGf 1
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PLAN CHECK NO.
OCCUPANCY - GROUP J
PLAN CHECK FEE $