HomeMy WebLinkAboutF2019-0099 - Permit Applicationoq,42 ,Z0jq
Worksheet for Fire Permit Application.
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # X Fire Sprinkler ri Fire Alarm n Fire Misc
1. Project Address (Not mailing address) Floor Suite No
2�-q F
Tenant NameVI-TY �/v I,OOP41 _..j #Units
v !� /�
2. Description of Work
Use
Stater � Zip Telephone �—
140 el � 1a `j _ � � F,re S•�r •�l lr/rrs I
Name Last I ��� ?. First �� Lic. No.
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Valuation $ , 6o0
Extg Sq Ft F F �
New/Added Sq Ft i Total Sq Ft ! I
1 ---
F 5. Engineer's Name
# Stories
New F_ Add F7 Alter F_ Demo
Engineer's E-mail Address
Check Appropriate Box for Applicant/Notification
[; 3. Owner's Name
Last a First -,
Owner's Address
Owner's E-mail Address
I
City.
Stater � Zip Telephone �—
F_4. Arch itect/Designer's
Name Last I ��� ?. First �� Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
--
State F Zip l i Telephone
F 5. Engineer's Name
Last ✓l First F3,,c-;z Lic. No. F
/
Engineer's Address
Engineer's E-mail Address
`l
City I'•'t_ H f
State c'A..._ Zip Telephoned _
r 6. Contractor's Name
Last %} hE;( r,),e. S ✓S yt S First _777- First Lic. No. F Class l6
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Contractor's Address
Contractor's E-mail Address
City'.xr„ t s
-. State C/f-. Zip %Z b�� TelephoneNI.1'33 %".`p67`
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OFFICE USE ONLY
p PERMIT NO.
1
TYPE OF CONSTRUCTION Y� PLAN CHECK NO.
OCCUPANCY- GROUP
�� I . �b �—PLAN CHECK FEE $ �� 71b
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