HomeMy WebLinkAboutF2019-0090 - Permit ApplicationWorksheet for Fire Permit Application
C City of Newport Beach - Building Division
Please print 3 copies 2Q V — 00-73
Associated Building Permit # /`� _moo � Fire Sprinkler Fire Alarm F Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
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Tenant Name
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Zip
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First �— Lic. No. —
Architect/Designer's Address
Architect/Designer's E-mail Address
2. Description of Work
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First Lic No. ��—
Engineer's Address
Qvi l Lis
Engineer's E-mail Address
Extg Sq Ft --!
New/Added Sq Ft
Total Sq Ft -i;
Valuation $ jU c,w
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F-! New F_ Add F` Alter F_ Demo
First Lnc. No. F gto ?Class
# Stories F
Check Appropriate Box for Applicant/Notification
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F7 3. Owner's Name Last--
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Owner's Address
Owner's E-mail Address
City �-
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Zip
4. Architect/Designer's Name
Last L 2
First �— Lic. No. —
Architect/Designer's Address
Architect/Designer's E-mail Address
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5. Engineer's Name Last
First Lic No. ��—
Engineer's Address
Engineer's E-mail Address
City
State I
Zip Telephone
F76. Contractor's Name Last
First Lnc. No. F gto ?Class
Contractor's Address
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Contractor's E-mail Address
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OFFICE USE ONLY
PERMIT NO. S (iri I 0
TYPE OF CONSTRUCTION
PLAN CHECK NO. 0 3K �;zc) 1
OCCUPANCY - GROUP
PLAN CHECK FEE $