HomeMy WebLinkAboutF2019-0218 - Permit ApplicationPrint Form ; / _ �A
Please print 3 copies r 1/l
Associated Building Permit #
Worksheet for Fire Permit Application
VZkq City of Newport Beach - Building Division
r`Fire Sprinkler F Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Last First
Tenant Name �� 2 �C` 9u� Unts
2. Description of Work
City
State ��' Zip � Telephoned---'.
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Extg Sq Ft ��, New/Added Sq Ft I - Total Sq Ft'
Valuation $ I Zsbc) —'
I` New Add F- Alter F_Demo
# Stories
State F_Zip I Telephones
5. Engineer's Name
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name
Last First
Owner's Address
Owner's E-mail Address
City
State ��' Zip � Telephoned---'.
r 4. Architect/Designer's
Name Last Ly_<<� First C/,' Lic. No. --
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State F_Zip I Telephones
5. Engineer's Name
Last � First F_, Lic No.
Engineer's Address
Engineer's E-mail Address
City
State—' Zip Telephone
F_ 6. Contractor's Name
Last First/ Lic.No. gtZ/'7 Class', C -/6
Contractor's Address
Contractor's E-mail Address
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City ���Jy� �� ��
State Zip 6 Telephone glfd_ZC/'3 <(
Of1Fl USE ONLY
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PERMITNO. 10)
_'E F CONSTRUCTION PLAN CHECK NO.
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U ANCY -GROUP
PLAN CHECK FEE $