HomeMy WebLinkAboutF2019-0154 - Permit Application()43,2-2olq
Worksheet for Fire Permit Application -0 16#
City of Newport Beach - Building Division
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Please print 3 copies
Associated Building Permit# �— F7 Fire Sprinkler F. Fire Alarm
r; Fire Mix
1. Project Address (Not mailing address) FloorSuiteSuite No
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Tenant Name rS. C��Y �S, � ���'¢'(�S #Units II
2. Description of Work
Owner's E-mail Address
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Valuation $S- oCJ n
New r Add Iter Demo
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# Stories
Check Appropriate Box for Applicant/Notification
f7, 3. Owner's Name Last
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First
Owner's Address
Owner's E-mail Address
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F- 4. ArchitecUDesigner's Name
Last D&V,,G, First jSt,yye, :, Lic. No. —,
Architect/Designer's Address
Architect/Designer's E-mail Address _
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5. Engineer's Name Last
First Lic No.
Engineer's Address
Engineer's E-mail Address
City
State�—
Zip F Telephone-'—�
f 6. Contractor's Name Last�u�Ns First— Lic.No. F? 71177- ClassF�'
Contractor's Address
Contractor's E-mail Address
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Zip 9 87 Telephone lq , elo& 76.5<'
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $