HomeMy WebLinkAboutF2019-0422 - Permit ApplicationWorksheet for Fire Permit Application 106°1-201Q qaqw
City of Newport Beach - Building Division �20f9-0y22 Please print 3 copies
Associated Building Permit# �— I Fire Sprinkler F'j Fire Alarm F71 Fire Misc
1. Project Address (Not mailing address) Floor Suite No `
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Tenant Name [3..fi _v 1/�.1^iV Fr? USe-/-#Units
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2. Description of Work
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Use
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E#g Sq Ft New/Added Sq Ft F_____7; Total Sq Ft F_Valuation
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$ ,Z OO --
FL,New Add r% After [7#
Demo
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Check Appropriate Box for Applicant/Notification
3. Owner's Name Last F
1 First F---,
Owner's Address
Owner's E-mail Address
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State F I Zip �.... Telephoned -..-.
4. ArchitecUDesigner's Name Last
�— First F-- Lic No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I--. ..._.
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State I_—..... Zip Telephone[__�..._ _
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[-'•••••... 5. Engineer's Name Last /'V_ (G� r,,✓ First L�� _ Lic. No, l �.
Engineer's Address
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Engineer's E-mail Address
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State Zip Telephone
4(_!"343-7_ tips F ?S'/-7
[i 6. Contractor's Name Last First ( -- Lic. No.
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Contractor's Address
Contractor's E-mail Address
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_ S a/N
City f�- rr� i 3G
State �— Zip f G 2_&2,1C Telephone ?/L(' 10 ? 7 SA -
OFFICE USE ONLY
PERMIT NO. 14 . D 1•
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
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PLAN CHECK NO.
' \ u PLAN CHECK
10M FEE $
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