HomeMy WebLinkAboutF2019-0167 - Permit ApplicationW
Print Form
Worksheet for Fire Permit Application
City of Newport Beach -Building Division
Please print 3 copies I C1 — �j
Associated Building Permit# I X94)`I, 010p<� r Fire Sprinkler F_ Fire Alarm r Fire Misc
1.!Project Address (Not mailing address) Floor Suite No
/
�5?6 / W_` L704 57— /� Y
Tenant Name /+/L(/%'; /Lj &---GJ 00 k!7— # Units
2. Description of Work
City �
State � Zip � TelephoneF_
4. Arch itectlDesigner's NameLast
%`ITZ'(-FCs/J lfd�/� (CiYCC� SU��1Z�5'S19 ���'TZ'r/vl
use
Architect/Designer's E-mail Address
Valua on $
Extg Sq Ft �— New/Added Sq Ft � Total Sq Ft F'
City 721(0 Lr 0-- _.__.
State Zip R/'7"f Telephone ROg—VW , r,5-(7
# Stories
p New F, Add F_ Alter r, Demo
Engineer's Address
Check Appropriate Box for ApplicanVNotification
Infnrmnff^n
F— 3. Owner's Name Last
F First
Owner's Address
Owner's E-mail Address
City �
State � Zip � TelephoneF_
4. Arch itectlDesigner's NameLast
First) J� Lic. No. F',
Architect/Designer's Address
Architect/Designer's E-mail Address
City 721(0 Lr 0-- _.__.
State Zip R/'7"f Telephone ROg—VW , r,5-(7
F_ 5. Engineer's Name Last
F First I Lic. No. F --
Engineer's Address
Engineer's E-mail Address
City
State I Zip � Telephone
6. Contractor's N Last UY4 �i�4 S���7�Fi �— Lic. No. �"/G Class
Contractor's Address ` �A Contractor's E-mail Address
6. go /\, �gq3
City Q YJ n t t r,L5—
State Zip Telephone[T R
OFFICE USE ONLY
�/ Z PERMIT NO. 0
TYPE OF CONSTRUCTION
_
I`~w PLAN CHECK NO.
OCCUPANCY- GROUP
1 �1 PLAN CHECK FEE $