HomeMy WebLinkAboutF2019-0470 - Permit ApplicationPrint Form
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Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
10 0
F20*0y70
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�<IC NSP
kFireSprinklerI-Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
Floor
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Suite No
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Owner's E-mail Address
Tenant Name i
# Units
City �7V �" ��� /
� �{� State f C�'-t' Zip [_ TelephoneF_
' Lic. No.
Vv
F_ f� to esigner's Narom Last I n 1 ^ , First WE-maild
2. Description of Work
ArchitecUDe igner's Addres
U.
ArchitecUDesignerP'
7
Las
Flrcc S_etztI4 Las (S-
Use
CD
F_ 5. Engineer's Name
Last First [_ Lic. No.
Extg Sq Ft F— — New/Added Sq Ft Ft
-. Valuation $:: I
.IMP
City
State �� Zip Telephone
New Add r Alter Demo
# Stories
Last j Jj Jf First i — Lic. No. `� j Class'
Check Appropriate Box for Applicant/Notif!cation
F_ 3. Owner's Name
Last First r -
Owner's Address
Owner's E-mail Address
City �7V �" ��� /
� �{� State f C�'-t' Zip [_ TelephoneF_
' Lic. No.
Vv
F_ f� to esigner's Narom Last I n 1 ^ , First WE-maild
f -
ArchitecUDe igner's Addres
U.
ArchitecUDesignerP'
City
State Zip F TelephoneF_
F_ 5. Engineer's Name
Last First [_ Lic. No.
�-..--
Engineer's Address
Engineer's E-mail Address
City
State �� Zip Telephone
F-6. Contractor's Name
Last j Jj Jf First i — Lic. No. `� j Class'
Contractor's Address
Contractor's E-mail Addr
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City
tate F....ZP_.. Zip `1 j6 Zp Telephone 9V .? V- r,?71
OFFICE USE ONLY
C)i 1 =� PERMIT NO.
l �J
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP�26.�
/ , P NCH CK FEE $
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