HomeMy WebLinkAboutF2020-0172 - Permit Application (3)Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit i! Fire Sprinkler
Fire Alarm F1, Fire Misc
1. Project Address (Not mailing address)
Tenant Name K4 to �VJ
2. Description of Work
Extg. Sit Ft F I New/Added Sq Ft Total Sit Ft
F New i- Add r Alter F_ Demo
Check Appropriate Box for ApplicantlNotification
Floor
Suite No
15-0
1_k�C
N Units
Use
I I
Valuation $ y
p Stories
(-I 3.Owner's Name
Last 1 Z� IItI�� First
Owner's Address
Owner's E-mail Address
City "��?�+��
IF
-' State
Zip l l(�- Telephone)
F- 4. Architect/Designer's Name Last
First
Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F
Zip �— '. Telephone)
r' 5. Engineer's Name
Last -rAl l -
I
First rj 6k
Lic. No, l
Engineer's Address _ /
�JW�� W
Engineer's E-mail Address
City 4`:j4��
State ,r.�
Zip ` Telephone
G
( 6. Contractor's Name Last
�� �IA/wj�Firstl LicNo (
I I'
Class[
Contractor's Address
Contractor's E-mail Address
City
State
Zip Telephor i
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $ ®-�--