HomeMy WebLinkAboutF2019-0309 - Permit ApplicationWorksheet for Fire Permit Application //73 ,?0/9
City of Newport Beach - Building Division FZOl9 -o 3Q 7 q 0
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Associated Building Permit# X Fire Sprinkler ri Fire Alarm rl Fire Misc
1. Project Address (Not mailing address) Suite No
hFloor
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Tenant Name -� # Units
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2. Description of Work
Owner's E-mail Address
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_ State�/� Zip
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9�$(p� Telephone[—_-
Extg Sq Ft New/Added Sq FtL� Total Sq Ft
Valuation $ //p�
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Architect/Desig �s-Address—
ories
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n New Add Alter Demo
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Check Appropriate Box for Applicant/Notification',
r; 3. Owner's Name
Last ���ycC�Qy
First
Owner's Address
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Owner's E-mail Address
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F-, Designer's Name L st ��/j F�j�
I First /�e -% Lic. No. F
Architect/Desig �s-Address—
Architect/Designer's E-mail Address
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State
F_City Telephon
Zip F— e
5. Engineer's Name
Last i
First—Lic. No.
Engineer's Address
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Engineer's E-mail Address - -
City �—
State [-- Zip
-- - Telephone��
F7 6. Contractor's Name
Last I
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First—, Lic. No. r ClassF
Contractor's Address
Contractor's E-mail Address�(J vl�'
City �_--
State pp
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OFFICE USE ONLY
PERMIT NO. 1
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
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