HomeMy WebLinkAboutF2020-0005 - Permit Applicationorksheet for Fire Permit Application
U-K City of Newport Beach - Building Division
Please print 3 copies
Associat d B •Id'
e w ing Permit # I ��.(�� Fire Sprinkler F'i Fire Alarm rl Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name �l� %1 ,?,
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2. Description of Work
PA �•GL! t4v LO GLdc( �3 �i✓e 57�S eiaJ / Use
Extg Sq Ft -- New/Added Sq Ft F Total,Sq Ft �] j � Valuation $ f"�
17, New F_ Add Alter F' Demo # Stories O)i
Check Appropriate Box for ApplicantlNotification
�Q. Owner's Name Last
i First F---
Ow �`s^Ad((dress
Owner's E-mail Address
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City
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State �r7
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Zip I///i////P3 Telephone
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{4.Arch itecVDesigner'sName Last
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_ Lic. No.
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Architect/Designer's Address
Architect/Designer's E-mail Address
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City ff ! -
State
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Zip r TelephonelU.y r/ 60-\ L 9'ri/�'T
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- 5. Engineer's Name Last
1
First % E
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Engineer's Address
EngineersE-mail
/A�/ddress
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City
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Zip r�'�! Telephone �'Lj
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6. Contractor's Name Last I
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/ I P�(,iti/1 Lic No. I[J�f f V Class) 1//
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Contractor's Address
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Contrac or's E-mail Address ,
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City
State 1 W'1'
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Zip Telephonel
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ONLY Lbt�CtPERMIT NO.
\ v `PLAN
rOFFICEE
^\.�ONSTRUCTION
CHECK NO. W 3 OZ�Y
- GROUP
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(� PLAN CHECK FEE $
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