HomeMy WebLinkAboutF2019-0054 - Permit ApplicationPlease print 3 copies
Associated Building Permit #
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Worksheet for Fire Permit Application F,2o14-005N ap'sw "
City of Newport Beach - Building Division o
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Floor Suite No
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Tenant Name #Units
2. Description of Work
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Valuation $ 4F n r
Eztg Sq Ft �.7i 7>�i ! New/Added Sq Ft Total Sq Ft _, �r WI
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New r' Add "' \ Alter (7!, Demo
Check Appropriate Box for Applicant/Notification
(- 3. Owner's Name Last First F
Owner's Address Owner's E-mail Address
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City F State F Zip F TelephoneF
F- 4. ArchitectiDesigner's Name Last F First r Lic No.
Architect/Designees Address Architect/Designers E-mail Address
City State �— Zip �— Telephoners
F7 5. Engineer's Name Last First F Lic. No.
Engineers Address Engineer's E-mail Address
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City State F—�, Zip � Telephone��
I 6. Contractor's Name Last �a� First S-I`I vC Lic. No. q� �� Class 3lQ WOU
Contractors Address � � '1 �6 r',� Contractor's E-mail Address
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city �gn� O, State Zip ���(�� Telephone�iW?�
OFFICE USE ONLY ��✓ Ilk PERMIT NO.
TYPE OF CONSTRUCTION p l� l '� PLAN CHECK NO.
OCCUPANCY- GROUP T PLAN CHECK FEE $
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