HomeMy WebLinkAboutF2019-0259 - Permit Application (2)F!-1Ul�1' 0 C1 Worksheet for Fire Permit Application o4 W`°"s
City of Newport Beach - Building Division
Please print 3 copies «;,oar"
Associated Building Permit # Fire Sprinkler F_ Fire Alarm (–' Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
First F—
Owner's Address
F
Tenant Name
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#Units
2. Description
of Work
Use
1. /G
(% I. X S
EMg Sq Ft
New/Added Sq Ft— Total Sq Ft—;
State—',,
Valuation $
---
(; New r
Add Alter Demo
First F Lic. No. F_
# Stories
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last l—
First F—
Owner's Address
Owner's E-mail Address
City �—
._..-------
State ��
Zip F—... Telephone
4. Arch itectfDesigner's Name Last
First Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
city--
State—',,
Zip r Telephone
r' S. Engineer's Name Last �
First F Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City F.--_ _
State F_,
Zip , Telephone
(-'�J. 6. Contractor's Name Last �iJ.� !� First Li N ll�Cj(
Contractor's Address
Contractor's E-mail Address
City�00j / �, ��„ �g
State
Zip f W Telephony % ✓r�(�l,C.�
OFFICE USE ONLY
NO. 'W YI Owl
TYPE OF CONSTRUCTION
b
l�4PERMIT
PLAN CHECK NO. (71 1124 lc1c�
O CUPANCY - GROUP
PLAN CHECK FEE $