HomeMy WebLinkAboutF2019-0125 - Permit ApplicationI_ o i ,2 ONorksheet for Fire Permit Application
V I ,�w, City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit #
Fire Sprinkler ❑ Fire Alarm F-1 Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
FS
Tenant Name �f 1 j # Units F
2. Description of Work
Owner's Address
Use
1AI
_i State �) Zip �—.. Telephoner—
Valuation S �Cyp
Extg'meq Ft I New/Added Sq Ft; I Total Sq Ft F—
Architect/Designer's E-mail Address
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Check Appropriate Box for Applicant/Notification
rl 3. Owner's Name
Last First
Owner's Address
Owner's E- Addr s
City �
1AI
_i State �) Zip �—.. Telephoner—
f— 4. Architect/Designer's Name Last First— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �.. Zip �_----� Telephone
r7 5. Engineer's Name
Last ��� First /J�— Lic. No. Fq 63
Engineer's Address
Engineer's E-mail Address
City
State Zip __ /.-(O 7._'_-.; Telephone %'(
(!6.Contractor's Name Last
r�-..2,3.j.,a
FirstFx ve Lic No. 1)D( ClassrGI(o
/
Contractor's Address
Contractor's E-mail Address
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City
rte_ i k
7
- State CAZip a 9 Telephoners
OFFICE USE ONLY
PERMIT NO. I%5)
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $