HomeMy WebLinkAboutF2019-0084 - Permit Application03f0_1�01q a�W�
Worksheet for Fire Permit Application )"ZQiR.0084 z`
City of Newport Beach - Building Division o
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Associated Building Permit #I— i j— Fire Sprinkler (71Fire Alarm j7 Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
Owner's Address/
Owner's E-mail Address
city
Tenant Name
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# Units
2. Description of Work
City
State Zipf ---- Telephoned
r" 5. Engineer's Name
Last First Lic No.
Use
Extg Sq Ft ��
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New/Added Sq Ft `?...�'� Total Sq Ft l l
Valuation $
New Add r, Alter Demo
# Stories
Check Appropriate Box for Applicant/Notification
3. Owner's Name
Last 5�1. JC�1, j First
Owner's Address/
Owner's E-mail Address
city
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State I ' Zip F777 Telephoner��
First Lic. No.l,.
Name Last(�,Architect/Desi
ArchitecUDesigneDr'ssAdd Address
E-mail
City
State Zipf ---- Telephoned
r" 5. Engineer's Name
Last First Lic No.
Engineer's Address
Engineer's E-mail Address
city
State � Zip F—I Telephone—
C!6. Contractor's Name Last FlFirst �� �5 Lic. No. (� 883�f�Class
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Contractor's Address
Contractor's E-mail Address -
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