HomeMy WebLinkAboutF2019-0186 - Permit ApplicationWorksheet for Fire Permit Application 101,
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Print Form' 1 tl �^ ,F t=q �c)lq Lo City of Newport Beach - Building Division Please print 3 copies v lis � `(f( , 0 1, q ^T �Foa
Associated Building Permit# // 1 ) ` 1F Fire Sprinkler F_ FirleAlarm r'FireMisc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name A b L_ # Units �-
2. Description of Work
Use
Owner's E-mail Address
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Extg Sq Ft � New/Added Sq Ft � Total Sq Ft I�'
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State Zip
# Stories
�', New r Add F_ Alter F-Demo
Last
Check Appropriate Box for Applicant/Notification
Information
F_ 3. Owner's Name Last
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First
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Owner's Address
Owner's E-mail Address
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State Zip
ZIP Telephone-.---..-. --.,
F_ 4. Arch itect/Designer's Name
Last
First F — -- Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_ Zip
�� Telephoned
F- 5. Engineer's Name Last
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First F_ Lic. No. CoZ`2`1`I 3
Engineer's Address
Engineer's E-mail Address
City
State Zip
F_ Telephone
F_ 6. Contractor's Name Last �✓ i PV(V F-1Iti First Lic. No. 2 9 CId55 tl/
Contractor's Address
Contractor's E-mail Address
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City C �� , ���
State e -W Zip
q?,4t Telephone C4 (,-1 Z L( I
OFFICE USE ONLY
PERMIT NO. r-IG�B
TYPE OF CONSTRUCTION
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PLAN CHECK NO. (27'10 ^ ZQ V_/
OCCUPANCY- GROUP
PLAN CHECK FEE $ �j