HomeMy WebLinkAboutF2019-0630 - Permit ApplicationWorksheet for Fire Permit Applicatii
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # I i ;Fire Sprinkler r; Fire Ala
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1. Project Address (Not mailing address)
1 a7 E. 4PV4 �,--f Aim
Tenant Name
2. Description of Work
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Extg Sq FtTotalNew/Added Sq Ft Total Sq Ft
Pel ? F
New j— Add ( Alter F.— Dem
Check Appropriate Box for Applicant/Notification
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# Units
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Valuation $ 4rn'o
# Stories 0
r. 3. Owner's Name Last
First
Owner's AddressOwner's
E-mail Address
City F_
I State
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ZipZip Telephone
(` 4. Architect/Designer's Name
Last i First �— Lic. No.-
ArchitecUDesigners Address
Architect/Designees E-mail Address
city
State-.
Zip f -----, Telephoner '
F 5. Engineer's Name Last
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First t Lic. No.
Engineer's Address
Engineer's Email Address
City
State F_
Zip- Telephonet
(�6. Contractor's Name Last
First /y/� Lic No. �y�//s Class
Contractor's Address
Contractor's E-mail Address
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`State I ""
Zip p,'}CrS'7s Telephone CgVr9)its.;Iy�
OFFICE USE ONLY
1 �1 L�:�
PERMIT NO.
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
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PLAN CHECK NO. G
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PLAN CHECK FEE $