HomeMy WebLinkAboutF2017-0166 - Permit Application��200 �I Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # n Fire Sprinkler (-; Fire Alarm r; Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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200 q �e erfc`v
Name # Units
Tenant
2. Description of Work
Use
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Zip F— Telephone
Valuation $ S 000
Ed S Ft �i New/Added Sq Ft Total Sq Ft
9 9 �ii ._. _-- ----.�
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# Stories
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F, New F_ Add F- Alter F7 Demo
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Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
First
Owner's Address
O ner's E-mail Address
Ow
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City State ��
Zip F— Telephone
F_ 4. Architect/Designer's Name Last VI G First p � rit Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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rYe v�ri'dSs�JvLrarl com
CityL.-t0 State[ A —Zip
C�l�rl� _ 1.
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r, 5. Engineer's Name Last
First �— Lic No. —
Engineer's Address
Engineer's E-mail Address
City _- -. State F777
Zip s, Telephone[? - 11
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16. Contractor's Name Last T I KC, (/ IIP First �, Lic No. 9�zc0 Class w
Contractor's Address
Contractor's E-mail Address
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city ��� .. State C�—',
Zip 4/al-go Telephone C'7/y13(0.-9/e( �
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PERMIT NO. �/ v l ' 01
OFFICE USE ONLY
TYPE OF CONSTRUCTION
PLAN CHECK NO. lot
OCCUPANCY - GROUP J . \L�
PLAN CHECK FEE $
L ID 2&19- — 0140