HomeMy WebLinkAboutF2019-0361 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies F%/fl I Gj • �?JlQ I
Associated Building Permit#
j j Fire Sprinkler (-i Fire Alarm (` Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
Tenant Name `�V���`� �-E,C�tf� �,..��� I #Units �,..
2. Description of Work
Owner's Address
Owner's E-mail Address
Use
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Valuation $T_
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Extg Sq Ft New/Added Sq Ft Total Sq Ft ,: "' F'�� i
New F/ -Add F - Alter FV -/Demo
# Stories
Check Appropriate Box for Applicant/Notification
F: 3. Owner's Name Last
First[ -
Owner's Address
Owner's E-mail Address
City—
,.;State
Zip--- Telephone F�
4. Architect/Designer's Name Last
First r--' Lic. No
F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City'-—
State
F_ Zip ��! Telephoned
F 5. Engineer's Name Last l-
First -- Lic. No.
Engineer's Address
Engineer's E-mail Address
City i'
State ,
Zip F_' Telephoner--
j -i5. Contractor's Name Last n� �`/ �a �, FirstLic.No.yassF
Contractor's Address
Contractor's E-mail Address
.._State
_
City
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Zip —7 Telephone
OFFICE USE ONLY
PERMIT NO.
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TYPE OF CONSTRUCTION
PLAN CHECK NO. A—
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OCCUPANCY - GROUP
PLAN CHECK FEE $
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