HomeMy WebLinkAboutF2023-0574 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies doP
Associated Building Permit # ire Sprinkler r Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Per Iz
Tenant Name Z_lZ ,t 1�i # Units �—
2. Description of Work '7P
Use � j
�1
Extg Sq Ft F New/Added Sq Ft �7Q Total Sq Ft Valuation $
I— New r Add r Alter r Demo # Stories
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name
Last L I Z 4k-D r
First F-
Owner's Address
Owner's E-mail Address
City —_
State
Zip �— Telephoned
1— 4. Architect/Designer's
Name Last
First— Lic. No.
F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F—
Zip F Telephoned
5. Engineer's Name
Last
First F Lic No.
Engineer's Address
Engineer's E-mail Address
City
State F_
Zip [_ Telephoned
�6. Contractor's Name
Last A-Y/ First I � Lic. No. "KAo` Class��ij
Contractor's Address
//
Contractors E-mail Address
r�
b ZA- '/
ZD� ni'IZ.
`
City . 4i I .So Ur
State F�
Zip q�� 9 Telephone
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OFFICE USE ONLY
PERMIT NO. OZ e
O S1 if
TYPE OF CONSTRUCTION —
PLAN CHECK NO?t— 0
S
OCCUPANCY - GROUP
PLAN CHECK FEE $