HomeMy WebLinkAboutF2019-0061 - Permit ApplicationPlease print 3 copies
Associated Building Permit#
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
r,i Fire Sprinkler f] Fire Alarm j j Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name # Units I
2. Description of Work
Owner's E-mail Address
Use
State I
,I
Ft New/Added Sq Ft �,i Total Sq Ft
Extg Sq �
Valuation $�
Last
# Stories �I
ew j! Add j- Alter r Demo'
Check Appropriate Box for Applicant/Notification
rl 3. Owner's Name Last
First',
Owner's Address
Owner's E-mail Address
City
State I
Zip �� Telephoned
4. Arch itecUDesigner's Name
Last
FirstF Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State
F
Zip Telephone
FI - -_.
[,' 5. Engineer's Name Last
First F Lic No.
Engineer's Address
Engineer's E-mail Address
City
State
Zip F Telephone_--�
F76. Contractor's Name Last
_' Firsto Lic. No.ss C -`\P
Contractor's Address
Contractor's E-mail A dreS
City'
State
Zip
�°���
aP� ! Telephone
OFFICE USE ONLYQp�
PERMIT NO. ic�1ek • rL_(oI
TYPE OF CONSTRUCTION
1V
1
<<
f �f>V� PLAN CHECK NO. 0260 -20 1 ct
OCCUPANCY- GROUP
PLAN CHECK FEE $
X M l,� • o-)-) C7