HomeMy WebLinkAboutF2019-0227 - Permit ApplicationPrint Form
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Associated Building Permit #
Worksheet for Fire Permit Application ®$53`2®19U -
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City of Newport Beach - Building Division F��lq-t7 7
Fv-Fire Sprinkler r Fire Alarm (` Fire Misc
1. Project Address (Not mailing address) Floor Suite No
30 O�p� -OL vo _ IoW r. -..._...--..-
Tenant Name �7/JO 2� # Units ..................
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2. Description of Work
Use 'b
State �� Zip � Telephone)--'
r 4. Arch itect/Designer's Name Last Yq ` First Lic. No.
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Valuation $ 740, tt-
Extg Sq FtF
New/Added Sq Ft Total Sq Ft
City
New F_. Add F_ Alter F_ Demo
# Stories
Check Appropriate Box for Applicant/Notification
InfocMatmon
F_ 3. Owner's Name Last
First F
Owner's Address
Owner's E-mail Address
City
State �� Zip � Telephone)--'
r 4. Arch itect/Designer's Name Last Yq ` First Lic. No.
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Architect/Designer's Address
Architect/Designer's E-mail Address
City
State - Zip I Telephone 316 41s, rpp13
I_ 5. Engineer's Name Last
First I Lic. No. I
Engineer's Address
i
Engineer' -1 s
City
State Zip Telephone
F_ 6. Contractor's Name Last izu t-iw� F,x A�eiw� Lic. ss _ G 16
Contractor's Address
Contractor's E-mail Address
33S
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City
State F-/ Zip �+p� Telephone .700 -?f - 62 Z
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OFFICE USE ONLY
^ �t PERMIT NO.
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TYPE OF CONSTRUCTION
✓ ' PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE
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