HomeMy WebLinkAboutF2017-0562 - Permit Applicationr�
AO%• Wi,/ YOVor s eet for Fire Permit Application
City of Newpo Beach - Building Division
Please print 3 copies
Associated Building Permit # • `Fire Sprinkler F Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
Floor
Suite No
2L413 vv�w_ rSI i D('' ------
Tenant Name ��-���{��/' _
# Units
2. Description of Work Lq tt �v ��Yw �Klsfin
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Use
Extg Sq Ft I )" New/Added Sq Ft Total Sq Ft
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Valuation $
# Stories
I— New I" Add /K/Alter F— Demo
Check Appropriate Box for Applicant/Notification
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3. Owner's Name Last �c�{ V _r First�Y
Owner's Address Owner's E-mail Address
City State Zip Telephone[gWr, -- I _ext
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/4. ArchitectlDesigner's Name Last First � � Lic. No.
Architect/Designer's Addres�§ Architect/Designer's E-mail Address
11-U0 N - ___ �3 L
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City Ol vt� ��� -._. _.. State I Cnnn///.-111x .. -. Zip q Telephone JJ.`"t•ZQ )._U7. (I
( Engineer's Name Last 1y ,y 1 First Lic No. N
Engineer's Address err \\\mow"` 1" 1 Engineer's E-mail Address DDD
City ol�zi'c- __.... ._._ State. Zip �•'... Telephone
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Contractor's Name Lasf. RA n {� Sl� �J S(vV ` Lic. No. ljL� j�Class�
Contractor's Address G�n C�tr`�t� Z%II�GreS Contractor's E-mail Address
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City Od-� - -... State I_ _-.... Zip[,q�mTelephoned 02.(/ -e Kf 0
OFFICE USE ONLY PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY- GROUP PLAN CHECK FEE