HomeMy WebLinkAboutF2019-0254 - Permit ApplicationPlease print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Fire Sprinkler fI Fire Alarm
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FI Fire Misc
1. Project Address (Not mailing address) Floor Suite No
�— First r,.
Owner's Address
Tenant Name •� � �%( L. ,1 T" `/A
R/Li - # Units
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2. Description of Work
State rZip F TelephoneF�
F 4. Architect/Designer's Name
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Use
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Extg Sq Ft �)�SZXJ New/Added Sq Ft �Joa�F Total Sq Ft
Valuation $ w
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First Lic. No. F_
Demo
n New F_ Add (`Alter F_ Demo
#
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Check Appropriate Box for Applicant/Notification
F1 3. Owner's Name Last
�— First r,.
Owner's Address
Owner's E-mail Address
City
State rZip F TelephoneF�
F 4. Architect/Designer's Name
Last First— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State- Zip �---� Telephoner�r
5. Engineer's Name Last
First Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City �—
State Zip F_ Telephoned
Contractor's Name Last
I DS�LL First
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Contractor's Address
Contractor's E-mail Address
City co �
StateF Zip 7o � Telephone_
OFFICE USE ONLY
+ PERMIT NO.
TYPE OF CONSTRUCTION
OCCUPANCY -GROUP
PLAN CHECK NO. s ��
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6 � PLAN CHECK FEE $