HomeMy WebLinkAboutF2019-0600 - Permit ApplicationEW PO
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # _ - _ - _ ❑ Fire Sprinkler —11 Fire Alarm [- Fire Misc
1. Project Add ess (Not mailing address) Floor Suite No
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# Units
Tenant Name
2. Description of
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' Valuation $ jZ%�j
Extg Sq Ft �� New/Added Sq Ft �� Total Sq Ft
# Stories
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[7jNew F] Add ❑Alter E] Demo
Check Appropriate Box for Applicant/Notification
[, 3. Owner's Name- Last —C�_�` r First
Owner's Address Owner's E-mail Address
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city 'L� f State �� Zip _Z�_L - Telephone �'�,-
❑4. Architect/Designer's Name Last First Lic No.l J
Architect/Designer's Address Architect/Designer's E-mail Address
City _ _ State �� Zip Telephone
❑ 5. Engineer's Name Last -°'. �` I I First _ Z(G(/� Lie. No.
Engineer's Address Engineer's E-mail Address
Zip ) Tele C L.�/ SLG 1�)
City G-�j� tj ��%�._ State 1-C, Zi ( phone�-
J6. Contractor's Name Last ri- �tjC�
Llc. No. _ Class
Contractor's Address Contractor's E- ail Address
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City , State J Telephone
OFFICE USE ONLY PERMIT N0.
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TYPE OF CONSTRUCTION PLAN CHECK NO. OY
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OCCUPANCY- GROUP PLAN CHECK FEE $F(--