HomeMy WebLinkAboutF2019-0334 - Permit ApplicationP77 -0)q -o��y
Please print 3 copies
Associated Building Permit#
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
n Fire Sprinkler r"i Fire Alarm r, Fire Misc
1. Project Address (Notmailing address) Floor Suite No
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Tenant Name ' I Ott Dut P t (`c� C #Units
2. Description of Work
Owner's E-mail Address
Use
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Extg Sq Ft F-11 R
New/Added Sq Ft r—� Total Sq r�'�
Valuation $� s'C—
Last �— First -- Lic No. F
Architect/Designees Address
F7, New r' Add F— Alter r- Demo
# Stories ' 1
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Check Appropriate Box for Applicant/Notification
17 3. Owner's Name Last
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_ First r—'...
Owner's Address
Owner's E-mail Address
City
! State ��
Zip �—,. TelephoneF�.
j 4. Architect/Designer's Name
Last �— First -- Lic No. F
Architect/Designees Address
Architect/Designer's E-mail Address
City r-
State--
Zip r—--� Telephone
F 5. Engineer's Name Last
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—y Firsfr-- — Lic. No.
Engineer's Address
Engineer's E-mail Address'
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City �— _-...
State (--_
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Zip �_' Telephoned^ -..._
r' 6. Contractor's Name Last FA—p,-7• t First r -- Lic. No. 2 ' ,';. Class lc
Contractor's Address
Contractor's E-mail Address
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City rv� >^C
State L�(}-
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Zip %Z(,/y Telephone�9T? .3S' 79. 6;77
OFFICE USE ONLY
PERMIT NO. Z �t — O
TYPE OF CONSTRUCTION
PLAN CHECK NO. \25�' _ Zo i z�
OCCUPANCY - GROUP
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PLAN CHECK FEE $