HomeMy WebLinkAboutF2019-0670 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division A JP (� _ N ti4o
Please print 3 copies
Associated Building Permit 1 ( r Fire Sprinkler j Fire Alarm rj Fire Misc
1. Project Address (Not mailing addresy�s), Floor¢— Suite No
Tenant Name #Units
2. Description of Work
Use r
city --. _
Extg Sq Ft F_', New/Added Sq Ft-- Total Sq Ft [--�
Valuation $ •'�� j0
Stories
r New r Add r Alter r Demo
_
Check Appropriate Box for Applicant/Notification
F-1 3. Owner's Name Last fyvf' f First
Owner's Address
Owner's E-mail Address
city --. _
I
State
Zip F Telephone
F_ 4. Architect/Designer's Name Last
First
Lic. No _ --
Architect/Designer's Address
Architect/Designer's E-mail Address
city 17
State
Zip Telephone
5. Engineer's Name Last
�,4
t
First ( d7 r /i
/Address
Lic No. F—
Engineer's Address
Engineers E-mail
City � % NIVA'
S ate
Zip Telephoner ---;
r;16. Contractor's Name Last First r ' Lic No.
Class��
Contractor's Address
Contractor's E-mail Address
City
State .
�s
Zip I Telephoned
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $