HomeMy WebLinkAboutF2019-0191 - Permit Application.. HT
Worksheet for Fire Permit Application o� m
Print Form 1 City of Newport Beach - Building Division
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Please print 3 copies oar"
Associated Building Permit # Fire Sprinkler r', Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name IMAM # Units ,
2. Description of Work
City
Use
F_ 4. Architect/Designer's Name Last
Valuation $
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Extg Sq Ft 1---.-----', New/Added Sq Ft Total Sq Ft
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F_ New F_ Add Alter Demo
# Stories
Check Appropriate Box for ApplicantlNotification
F- 3. Owner's Name Last WIM No V t First
Owner's Address
Owner's E-mail Address
City
State r (W— Zip 54 I TelephoneF_
F_ 4. Architect/Designer's Name Last
I ll� First UW Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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City
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State Zip�//,1 `/ j�j n �ii TelephoneF_
F_ 5. Engineer's Name Last First I v Lic. No. --
Engineer's Address
Engineer's E-mail Address
City
State rJ IZip Telephone,,,
F_ 6. Contractor's Name Last
First Lic. No. Ya'� 4LN X Class rl
Contractor's Address
Contractor's E-mail Address
City
State Zip Telephone v
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OFFICE USE ONLYI
of 'p7�1 PERMIT NO.
TYPE OF CONSTRUCTION
)) ([� • 'b(�KI�PLAN CHECK NO. C)
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OCCUPANCY- GROUP
i PLAN CHECK FEE $
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