HomeMy WebLinkAboutF2019-0603 - Permit ApplicationWorksheet for Fire Permit Application oOM
Print Form e z
o3City of Newport Beach -Building Division ;,
Please print 3 copies tt l B +
Associated Building Permit# �— f�reSprinkler I- Fire Alarm I- Fire Misc
1. Project Address (Not mailing Floor Suite No
�address)
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Tenant Name LCr�] J�.. L # Units �-
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2. Description of Work
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guation
Last I `F; ?U -L First 'b 11. e� Lic. No. q t{
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Extg Sq Ft � New/Added Sq Ft �� Total Sq Ft F'
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(- New /Add Alter r Demo.
# Stories
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Check Appropriate Box for Applicant/Notification
F- 3. Owner's Name Last
(� ,}� First
Owner's Address
Owner's E-mail Address
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City I l rq � ,y 4ag,
State FE�k_ Zip 1 ------ Telephoned
F_ 4. Arch itect/Designer's Name
Last I `F; ?U -L First 'b 11. e� Lic. No. q t{
Architect/Designees Address
Architect/Designer's E-mail Address
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City 044, 1 CA
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State cZip � 1�5�Telephone �ll`{)�p[i�1y�
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J-" 5. Engineer's Name Last
First � Lic. No.
Engineer's Address
Engineer's E-mail Address
City �
State I— Zip F Telephone
I_ 6. Contractor's Name Last ( j V'L Firsts e l Lic. No. Class
Contractor's Address
Contractor's E-mail Address
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State 1 Zip j24$S�' Telephone t4,��_bl��
OFFICE USE ONLY
U .� PERMIT NO. 410
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY -GROUP
x%/11 PLAN CHECK FEE $