HomeMy WebLinkAboutF2019-0230 - Permit Application (2)Worksheet -for Fire Permit App@ication
City of Newport Beach - Building Division
Please print 3 copies F��"1 — D23a
Associated Buildinq Permit # - ❑ Fire Sprinkler - Fire Alarm ❑Fire Misc
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1. Project Address (Not mailing address) - R000r Suite No
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# Units
Tenant Name -
2. Description of Work
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City '�i(z .),t�%.
' Valuation $
E#g Sq Ft [= New/Added Sq Ft �� Total Sq Ft
Last Firsts Lic.No.
ArchitecUDesigner's Address
# Stories Ls�
LLLIIII
❑ New ❑ Add ❑ Alter ❑ Demo
State Zip Telephone—i
Check Appropriate Box for ApplicantlNotification
❑ 3. Owner's Name-
Last �1_ +�j � � q/�tirst��
Owners Address
Owner's E-mail Address
City '�i(z .),t�%.
State Zip _ –Z---�'� - Telephone _u...`_�"%_ 4����
❑4. Architect/Designer's Name
Last Firsts Lic.No.
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
city
State Zip Telephone—i
❑ 5. Engineer's Name
Last P First _ Z(fiLic. No
111111
Engineer's Address
Engineer's E-mail Address
�--`_–.—
v�_ Telephone
L�GG
61
---Stato zip
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[}6. Contractor's NameLastri
Uc. No. � �� Class
Contractor's Address
Contractor's E-mail Address
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City ___
_ _ —, State J Zip Telephone
OFFICE USE OPJLY
PERMIT NO. v
TYPE OF CONSTRUCTION
PLAN CHECK NO. tiU
OCCUPANCY - GROUP
PLAN CHECK FEE $