HomeMy WebLinkAboutF2019-0299 - Permit ApplicationPrint Form ua,�� Worksheet for Fire Permit Application 6130/9r -,2City of Newport Beach - Building Division F2019 - o2gqPlease print 3 copies
Associated Building Permit #
f Fire Sprinkler F_ Fire Alarm F Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
5120 C31(2G0
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Owner's E-mail Address
Tenant Name
City
# Units .--
2. Description of Work
F_ 4. Arch itect/Designer's
Name Last r- First r Lic. No.
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Use
Extg Sq Ft
New/Added Sq Ft Total Sq Ft
valuation $
-New
5. Engineer's Name
# Stories
FT, r Add
r Alter F-Demo
Engineer's E-mail Address
Check Appropriate Box for Applicant/Notification
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r 3. Owner's Name
Last First I
Owner's Address
Owner's E-mail Address
City
State �� Zip Telephone
F_ 4. Arch itect/Designer's
Name Last r- First r Lic. No.
F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip I Telephone,
5. Engineer's Name
Last Fye �. �.�� e •s First Lic. No.
Engineer's Address
Engineer's E-mail Address
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City I o4cvcO
State C ,,I Zip CWj6 ( Telephone I C'ccj _ cy7 S6!i
F_ 6. Contractor's Name
Last1(�O First ITUU Lic. No. -7Z c(cl 13 Class, G 16
Contractor's Address
Contractor's E-mail Address
310o E CFPA z s,
City D,1 ,, 1 0
State ( n Zip c(I G 3 Telephone[( 1611) 9y7 S(,75 -
(, 5 -OFFICE
OFFICEUSE ONLY
V1,V� 1 PERMIT NO. tj '
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TYPE OF CONSTRUCTION PLAN CHECK NO.
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OCCUPANCY- GROUP
P �j( ,'%� �f� PLAN CHECK FEE $
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