HomeMy WebLinkAboutF2019-0096 - Permit ApplicationPlease print 3 copies
Associated Building Permit#
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
X Z(�,� — OO r Fire Sprinkler r Fire Alarm
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F,40/R-00%
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F-11, Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name �yr6y � k.� # Units F
2. Description of Work
Use re-
1 1 1
_.._.
Extg Sq Ft ! New/Added Sq Ft Total Sq Ft
Valuation $ P.
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n New r Add r Alter r- Dema
# Stories
Check Appropriate Box for Applicant/Notification
1-4--41-
1773.
-4 –41
13. Owner's Name Last
First—
Owner's Address
Owner's E-mail Address
. City l t-v
State C. Zip Telephone[
r 4. ArchitecttDesigner's Name
Last (,,,�, "1
Z f� First :�\ Lic. No. r� 75
Architect/Designer's Address
Architect/Designer's E-mail Address
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State Zip Z6 S5 Telephonei14..3oq ua•tiCl
(. j 5. Engineer's Name Last
I First F---Lic. No. F_,
Engineer's Address
Engineer's E-mail Address
City �— _.
State F .... Zip Telephoned
F-76. Contractor's Name Last �r v� First o \ Lic. No. �S t28 Class G ` l b
Contractor's Address
Contractor's E-mail Address
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City I."J
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State r A _ Zip [4['2.GSY Telephone'rN4...3
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
OJT PLAN CHECK FEE $
57 L3