HomeMy WebLinkAboutX2019-2350 - Permit Application (2)009i
Worksheet for Fire Permit Application,���City of Newport Beach - Building Division 'X�j j ll < fl'
Please print 3 copies
Accnrintad Buildina Permit # f'.! Fire Sprinkler X Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
&_
-------
# Units
Tenant Name
2. Description of Work
Use �1
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1
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Valuation $
Extg Sq Ft r— -' New/Added Sq Ft
Total Sq Ft (-------:.
# Stories'
(' New (-, Add I Alter (— Demo
Check Appropriate Box for Applicant/Notitication
(-, 3. owner's Name Last51f?L,nil w First
Owner's Address owner's E-mail Address
yZ State Zip )
City ^�/H �.. �' ,{— — �t Telephone
r- 4. Architect/Designer's Name Last +F-�'� First Lic No. I�
Architect/Designer's Address Architect/Designer's E-mail Address
Cit y State Zip Telephone
CV'. 5. Engineer's Name Last lwv__IE First ' ' . Lic No.
Engineer's Address Engineer's E-mail Address
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City /'f •?=/�' p _._ .. State Zip + °�•1 Telephonedv i' j' a l ' /r
r Lic. No �� i /> . Class((
[ 6. Contractor's Name Last[--r))dna%v /4�Irirst� i �t
Contractor's Address
City 1... State
=FILE USE ONLY
F OF CONSTRUCTION
FANCY- GROUP
Contractor's E-mail Address
Zip Telephone!
PERMIT NO. 1!;4%!5 "
PLAN CHECK NO. ---®�=
PLAN CHECK FEE $