HomeMy WebLinkAboutF2019-0259 - Permit ApplicationF?'Olq-0Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit #---i j Fire Sprinkler [I Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Last I First F—',
Tenant Name Units I
2. Description of Work
City �—
State I Zip �- Telephone��
Use
k j 4 4- Kv2G 2r o 4 i L �--I— — /.� _ t % f 4-+ , ' S
Extg Sq FtNew/Added Sq Ft Total Sq Ft F j
Valuation
--
�! New r—Add(Alter � Demo
# Stories FT7
Check Appropriate Box for Applicant/Notification
F7, 3. Owner's Name
Last I First F—',
Owner's Address
Owner's E-mail Address
I
i
City �—
State I Zip �- Telephone��
F_ 4. Architect/Designer's Name Last First; Lic. No. �-
Architect/Designees Address
Architect/Designer's E-mail Address
City
State I Zip I Telephone
r' 5. Engineer's Name
Last-- First—— Lic No.
Engineer's Address
Engineer's E-mail Address
City. ---i
-.... State r—_.- Zip— Telephoned_ -.. -.
r'i6. Contractor's Name Last
�J First ! Li NC s
Contractor's Address
Contractor's E-mail Address
2r 4 --
city State —. Zip f �� Telephon �( b� LP --.
ii ��
OFFICE USE ONLY
PERMIT NO. W
TYPE OF CONSTRUCTION
11,0b l� V PLAN CHECK NO. 'IS' LCI
O CUPANCY - GROUP
PLAN CHECK FEE $