HomeMy WebLinkAboutF2020-0425 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # II Fire Sprinkler F-j Fire Alarm r; Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
LDN 63 2(S09 Ackov-ey l-� tav(- 4- -- -
Tenant Name ��LA ' #Units F-
2. Description of Work ' LJ
Use
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Extg Sq Ft New/Added Sq Ft 3taa i Total Sq Ft 31 �'
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Valuation $ a.aog
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K, New r Add r Alter r Demo
#Stories
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
city State F-1
Zip F Telephoned
r 4. ArchitectlDesigner's Name
Last Y- CA4vu do I. First `� Lic. No. F
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Architect/Designees Address
Architect/Designees E-mail Address
City
State �—
Zip f TelephoneF_
r 5. Engineer's Name Last
First Lic. No. a --
Engineer's Address
Engineers E-mail Address
City
State F--
Zip �— Telephone'
X6. Contractor's Name Last q� j e
V (`rho p First Ja"�� Lic. No. (�i Class C- G
Contractor's Address
Contractors E-mail Address
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city _ co)oO,Q _ -
-. State CI ^ -
Zijqa�-j 9 _ Telephone
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
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j� 0 PLAN CHECK FEE $