HomeMy WebLinkAboutF2019-0366 - Permit ApplicationZan -- C) T_-6;:0
orksheet -for Fire Permit Application
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City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit# _- _ _ _ ❑ Fire Sprinkler Xj Fire Alarm
1. Project Address
(7_ w
Tenant Name
mailing address)
2. Description of Work
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Extg Sq FL [--= New/Added-Sq Ft E:= --i Total Sq Ft
❑ New ❑ Add ❑ Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name- - LastCl��%j�'
Owners
`Address
City "'L� ) State
❑ 4. Architect/Designer's Name Last �—
Architect/Designer's Address
City _ � State J
❑ 5, Engineer's Name Last
Engineer's Address - /}
city State
[?6. Contractor's Name Last'
Contractor's Address
City
I State—
_-----.J
_.------------ — --
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY.- GROUP
�I Fire Misc
Floor
Suit No
�
If Units
Use
Valuation $
# Stories sl
I
,n 1/irst—�
+/Owner's E-mail Address
Zip Telephone
= Firstss Lic. No.
Architect/Designers E-mail Address
Zip Telephoned j
First (iV-"— Uc.No.��
Engineer's E-mail Address %-('-,
Zip �I—�_-- Telephone CLQ
Lic No. class—I
Contractors E-mail Address
Zip = Telephones s
PERMIT NO. -r ( — y d
PLAN CHECK N0. � 14L4
PLAN CHECK FEE $