HomeMy WebLinkAboutF2019-0476 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
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XFireSp mmei i Alarm
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F�O19-0[476
F Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name /_ r2w;�5_ # Units ,
2. Description of Work
Use
City
1
State F_Zip Telephone
4. Architect/Designer's Name
Last First I Lic. No. — -
Valuation $rl�jAv—
Extg Sq Ft �� New/Added Sq Ft Total Sq Ft �—
City
r -New r Add XAIter r Demo
# Stories F
Check Appropriate Box for Applicant/Notification
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3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City
1
State F_Zip Telephone
4. Architect/Designer's Name
Last First I Lic. No. — -
Architect/Designees Address
Architect/Designer's E-mail Address
City
State F Zip �� Telephoner-"
F_ 5. Engineer's Name Last
First I Lic. No. r
Engineer's Address
Engineer's E-mail Address
StateZip r Telephone
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�X6. Contractor's Name Last, I/ W', f A� Lic. No. �3a7Y� Class lG
r/v/
/Co`ntractor's
Address
Contractor's E-mail Address
70
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City Ul E
State ZipF? Cl Telephone)
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OFFICE USE ONLY
PERMIT NO. `� L
S� I "2aI
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TYPE OF CONSTRUCTION
i PLAN CHECK NO.
OCCUPANCY- GROUP
�_ PLAN CHECK FEE $