HomeMy WebLinkAboutX2019-3053 - Permit Application (4)Please print 3 copies
Associated Building Permit #
1. Project Address (Not
I 5 d`- 12, A-F
Work6heet'for Fire Permit Application UR11„City of Newport Beach - Building Division
/'2 1
Fire Sprinkler (- Fire Alarm Fire Misc (J 3, I4i700
mailing address)
Tenant Name�� 2e1 > I n
2. Description of Work
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Extg Sq Ft New/Added Sq Ft Total Sq Ft
New n Add � Alter r Demo e
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last
Owner's Address
City F— � State
4. ArchitectiDesigner's Name Last
Architect/Designer's Address
City �— --- State -
5. Engineer's Name
Owner's E-ma I Address
Floor Suite No
# Units F
Use
Valuation$
3
# Stories I t
ZIP Telephone
First Lic. No. F—
Architect/Designe\E-mail Address
Zip � Telephone —
Lic. No. F
Engineer's E-mail Address
ZIP �— Telephone
[] 6. Contractor's Name LastFV
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Contractor's Address
City � ti n� fd r� _Oz� State
Last ( %/z(SS0V1,1 _- - First I 0,4.vi
Engineer's Address
Ss-r�ee�—
City Q✓N(o( State
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
First) Se,:tA_) Lic. No. g7�3 Class C
Contractor's E-mail Address
SFln2tL tGvt v1 t tl -t polzchvj, Lc,,--
Zip 02G�e tG Telephone 71K
PERMIT NO. _
U I PLAN CHECK NO.
b�� Z PLAN CHECK FEE $