HomeMy WebLinkAboutF2019-0169 - Permit ApplicationPrint Form Worksheet for Fire Permit Application
F11 -o �q -01&q City of Newport Beach - Building Division
Blease print 3 copies
Associated Building Permit # I F_ Fire Sprinkler r Fire Alarm F_ Fire Misc
1. Project Address (Not mailing address)
ay"a01 °I u)I 1%0
RECEIVEDFloor` Suite No
2019 J
APR 2 4
Tenant Name DUB
`� � �i�ICUJ� /dM //
INTERWEST # Units
TING GROUP
2. Descriptions of Work
Use
Extg Sq Ft ��
New/Added Sq Ft F_ Total Sq Ft
F�'
Valuation $qiy�
i
F_ New r Add � Alter F_ Demo
# Stories F
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name Last First F_
Owner's Address Owner's E-mail Address
City F State F_ Zip I TelephoneF_
F_ 4. Architect/Desianer's Name Last / First �I Lic. No.
Architect/Designer's Address Architect/Designer's E -m Address
City T/ 7� iq% State �W, Zip �'�� Telephoner
F_ 5. Engineer's Name Last First I Lic. No.
Engineer's Address Engineer's E-mail Address
City I State w Zip F-, Telephoned
6. Contractor's Name Lasttri First �l � Lic. No. Lt 6 class,
Contractor's Address // Contractor's E-mail Address
City WNW State 9 Zip Telephone 7._ �714; 1
OFFICE USE ONLY PERMIT NO. �� I
TYPE OF CONSTRUCTION t��c� ti PLAN CHECK NO. ®'IZ-0 (G
OCCUPANCY - GROUP j/ PLAN CHECK FEE $
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