HomeMy WebLinkAboutF2019-0235 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
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1. Project Address (Not mailing address) Floor Suite No
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Tenant Name I TCk(D%� # Units r
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2. Description of Work
Use
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Zip [_ Telephone F_
Extg Sq Ft [_, New/Added Sq Ft [_Total Sq Ft
Valuation $ 'vs -0c) vn
F_ New r Add Alter (- Demo
# Stories F
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name Last
First F
Owner's Address
Owner's E-mail Address
City
State F_
Zip [_ Telephone F_
r 4. Architect/Designer's Name
Last L)Ukt First (�tNfI ,.( Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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F_ 5. Engineer's Name Last
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First U` Lic No.
Engineer's Address
Engineer's E-mail Address
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F_ 6. Contractor's Name Last At_w A-5; First Lic. No. 7%Z'?/ I Class ('-/0
Contractor's Address
Contractor's E-mail Address
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OFFICE USE ONLY
PERMIT NO.lq t72
TYPE OF CONSTRUCTION
PLAN CHECK NO. OE325> l�
OCCUPANCY- GROUP
PLAN CHECK FEE $