HomeMy WebLinkAboutF2019-0349 - Permit Application,Please print 3 copies
Associated Building Permit #
FXjq_03N4
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
1076-znv \
�s5t115h !; 15�Fire Sprinkler [7 Fire Alarm (- Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
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Tenant Name VO�I # Units
2. Description of Work
6
Use
5
v .S
Valuation $
Extg Sq Ft i)_ New/Added Sq Ft—, Total Sq Ft F4�0()()—,
# Stories
i-, New r Add 17,' Alter r, Demo
Check Appropriate Box for Applicant/Notification
i- 4. Architect/Designer's Name Last Nall( iz�u m t I I _ r Lic(. No.l pp ffn
Mehitect/Designer's Address -A EDesigner's E-mail Addres f \ . C S4� W '
City State Zip Telephone
5. Engineer's Name Last I First - Lic. No. IF
Engineers Address Engineer's E-mail Address
City State �- Zip J Telephone�—
r6. Contractor's Name Last dl �Q �t Lic No. ��y7�,t Class
Contractors Address Contractors E-mail Address
City I S&Ae, Atw, ..... _.., State �Cfn - Zip
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OFFICE USE ONLY PERMIT NO!i
TYPE OF CONSTRUCTION PLAN CHECK NO. _hiZCi ' [
OCCUPANCY - GROUP Y `e t _C) .-Z/"v PLAN CHECK FEE $ —