HomeMy WebLinkAboutF2019-0337 - Permit Application (2)Please print 3 copies
Associated Building Permit #
I. Project
Address (I
ISso ?oI
Worksheet for Fire Permit Application
City of Newport Beach - Building Division X'?t7t8 QUI a` m
/ b-0
9,F00.0.,P
❑Fire Sprinkler 1-i Fire Alarm JXFireMisc;Dlil'
mailing address)
Tenant Name I
2. Description of Work
Extg Sq Ft F j New/Added Sq Ft F , Total Sq F t
F7 G/
New � Add Alter Demo
Check Appropriate Box for ApplicantlNotification
�i
f' 3. Owner's Name
Last!%re�r!tc._ First
Owner's Add - �
Floor Suite No
# Units F
Use
i
Valuation $ /o - leer --d d
# Stories I j
ress
Owner's E-mail Address
City
State __0— Zip _ Telephone
r 4. Architect/Designer's Name Last
d5„s.�oN Lic. No.
Architect/Designer's Address First (' -� Architect/Designer's E-mail Address
city _ - ✓ " �(.Y.) � Li Sr��l n I�—��—�C—.
�.CI �/ems- --_ State ;;� Zip `� .�/-....-- TelephoneVT7-'.-`�'23-G/6o
n 5. Engineer's Name Last First---- (� -
.___. --.-._ _. _.. -_- Lic. No,
Engineer's Address,��r ./ J d�
� Engineer's E-mail Address
- State �_— Zip[_,Telephoner
[,7 6. contractor's Name Last / First ` 7. j-7
o� Lic. No.V6 e/p°I Class ,S
Contractor's Address Z5-�-� w% Contractor's E-mail Address
CLfN�E2r!/tL. r7lc','ar-af.'/illt_ L �?� ._.. _ - •��/��%--�.-
Cit /_
Y ✓ State�—
��?- Zip G,..7/0/ Telephone
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
PERMIT NO. tZ—U (i l
PLAN CHECK NO.—
PLAN CHECK FEE $