HomeMy WebLinkAboutF2019-0350 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # I �W 1,j (3 C 0 j,_ ire Sprinkler F_ Fire Alarm r; Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name vvtiwa --r't, , UAtl V__ # Units
2. Description of Work
Use
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valuation $ zl
Extg Sq Ft Sq Ft �—, Total Sq Ft F:
' New Add ,-Alter
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Check Appropriate Box for Applicant/Notification
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I--3.Owner's Name
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First
Owner's Address
Owner's E-mail Address
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City _�L6c-ei
State
ZipZip C( '2,(,Q(� Telephone—
F 4. Architect/Designer's Name
Last
FirstF Lic. No.�-
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_
Zip F_. Telephone
F 5. Engineer's Name
Last JO (. Jc7"W f,) First— Lic No.
Engineer's Address
Engineer's E-mail Address
City
State �—
Zip F_ Telephone
F 6. Contractor's Name Last
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Contractor's Address
Contractor's E-mail Address
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City l "L State
Zip 'Telephone"1.G)
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
-7
PLAN CHECK NO.-
OCCUPANCY - GROUP
PLAN CHECK FEE $
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