HomeMy WebLinkAboutF2019-0010 - Permit ApplicationWorksheet for Fire Permit Application (3) slpm-,City of Newport Beach -Building Divisionj Please print 3 copies `�q-Ci /�0\
Associated Building Permit #' Fire Sprinkler [ Fire Ala m r Fire Misc 1
1. Project Address (Not mailing address)
Floor Suite No
First—'
Owner's Address
.
Tenant Name
City _...
# Units
2. Description of Work
F_ 4. Architect/Designer's Name Last First DAli Lic. No.I
Use
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Extg Sq Ft ��
New/Added Sq R ��, Total Sq Ft '
Valuations V OCJ
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City UVQj (O -VI ACI
-Alter
# Stories
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(-i New (` Add F (^ Demo
Last
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name
Last
First—'
Owner's Address
Owner's E-mail Address
City _...
-- State F Zip
� Telephoned
F_ 4. Architect/Designer's Name Last First DAli Lic. No.I
Architect/Designees Address
Architect/Designer's E-mail Address
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City UVQj (O -VI ACI
-__ State CA Zip
9 / !CjU. Telephone m) 71�'17.4
F_ 5. Engineer's Name
Last
First F_Lic. No F_
Engineer's Address
Engineer's E-mail Address
City
.; State 1' Zip
F Telephone
F-6. Contractor's Name
Last
'Fre j 5 �e IQL
J
First Lic. No. �Zr0 Class `b
Contractor's Address
Contractor's E-mail Address
_b4-__ ilclarl'o Ave _ _ _ _
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City!SUV'{
--_- _-.... State Cl 4 Zip
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I�2(_ O -- Telephonel(71.)310_ej!q
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OFFICE USE ONLY
_ 2d / , n PERMIT NO. O,
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TYPE OF CONSTRUCTION
PLAN CHECK NO. IV
OCCUPANCY- GROUP
PLAN CHECK FEE $