HomeMy WebLinkAboutF2019-0046 - Permit ApplicationFZalc;t"fie
Worksheet -for Fire PermitApphication
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E-mail Address
Ownr's�
City of Newport Beach - Building Division
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Please print 3 copies
,Cary
I State �— Zip _�i(�_`` Telephone
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Associated Building Permit#
Fire SprinklerI Fire Alarm
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❑ Fire Misc
Name Last
1. Pro'ect Address (Not mailing address)
Floor
Suite No
City
State Zip = TelephoneF—,
Name
Last -° `. i First Z(G� Lic No.l
# Units
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Tenant Name
Engineer's Address
Engineer's E-mail Address
2 Descri tion of Work
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p Use
- Valuation $'Z/.
Extg Sq Ft �� New/Added Sq Ft �� Total Sq IT
# Stories
❑ New ❑ Add ❑ Alter ❑ Demo
(;hPrk AnnrODrlate Box for ApplicantlMotification
❑ 3. Owner's Name- .Last
lfrirst
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Owner's Address
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E-mail Address
Ownr's�
,Cary
I State �— Zip _�i(�_`` Telephone
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�� Lic. No.
7J4.First
4. Architect/Designer's
Name Last
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip = TelephoneF—,
Name
Last -° `. i First Z(G� Lic No.l
❑ S. Engineer's
_
Engineer's Address
Engineer's E-mail Address
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Lic. No. (alti2�bl�Class--
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[ }6. Contractor's Name
Last
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Contractor's Address
Contractor's E-mail Address
City
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OFFICE USE ONLY
PERMIT NO. -
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TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
1_
PLAN CHECK FEE $