HomeMy WebLinkAboutF2020-0101 - Permit ApplicationWorksheet for Fire Permit Application (r.City of Newport Beach - Building Division
Please print 3copies
Associated Building Permit #
j F/ -Fire Sprinkler F-1 Fire Alarm (i Fire Misc
1.. Project Address (Not mailing address) Floor Suite No
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Tenant Nameco(� \ --�#Units
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2.Description of Work
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Extg So Ft -- New/Added So Ft -j Total So Ft F --i
Valuation $ ,/ (y00 it
F-1 New F_ Add Alter [ Demo
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Check Appropriate Box for Applicant/Notification
3. Owner's Name LastPLFjrA 011 yr U'"'�� cam ,
Owner's Address
Owner's E-11 Address
City (.0 r �'1 g..--
! State FC ii Zip �_-- TelephoneF
4. Asehit9M Designees Name
Last ,- v Z 1 First p�r� Lic. No. G 16 SBej 2
`Desi nets Address
Arch itect/Desig ner's E-mail Address
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State j Zip Telephone -1/-�
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rl 5. Engineer's Name Last I—
First Lic. No.
Engineer's Address
Engineers E-mail Address
City
State �— Zip TelephoneF--�
F76. Contractor's Name Last corp,Z First oar �� Lic. No. �� � g� class C (fo
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Contractor's Address
Contractor's E-mail Address
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OFFICE USE ONLY
_ PERMIT NO. • d'®O
TYPE OF CONSTRUCTION
PLAN CHECK NO. `
OCCUPANCY - GROUP
Ia , ipl AN CHECK FEE $
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