HomeMy WebLinkAboutF2019-0219 - Permit ApplicationWorksheet for Fire Permit Applicat'Q
Print Form City of Newport Beach -Building Division
Please print 3 copies��(_
Associated Building Permit#I 2O)F� FX Fire Sprinkler F- Fire Alarm [ Fire Misc
U
No
1. Project Address (Not mailing address) F r Suited 4--
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/ #Units j—
Tenant Name �LG W �'r-` ci�'),l I � _ I
2. Description of Work
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Valuation $ r
g New/Added Sq Ft � Total Sq Ft Z,c-S
Ext Sq Ft � ��
# Stories
j New (- Add Alter r Demo
Check Appropriate Box for Applicant/Notification
F- 3. Owner's Name Last v x ��NC�P1S First,
Owner's Address Owner's E-mail Address
city
1 rt�(j l State I ! 1 ` Zip Ca�-[� Telephone cC)%'Zp9- `3 �
F- 4. Arch itect/Designer's Name Last Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip F_TelephoneF�
F- 5. Engineer's Name Last F� First F_' Lic. No. F�
Engineer's Address Engineer's E -mai hies$--
City State F Zip F_ Telephone
F- 6. Contractor's Name Last P (Z ` First 5 l ZU C Lic. No. I 9` n glass �- I
Contractor's Address Contractor's E-mail Address �"
Tc,, '�ck Zc� �7 Vccm Ct c -C tri r,� Cox, C T
city F L.k�-_�.o\c State FC—0 zip D,?Q rJ Telephone I- y?9
OFFICE USE ONLY
PERMIT NO. PZZIL�1'002 L9
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TYPE OF CONSTRUCTION PLAN CHECK NO. b9b5 -Do1
OCCUPANCY- GROUP PLAN CHECK FEE $