HomeMy WebLinkAboutF2019-0102 - Permit ApplicationF-1-0 `':� _O I Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit# r--- Fire Sprinkler rI Fire Alarm r-! Fire Misc
1. Project Address (Not mailing address)
14
Tenant Name
2. Description of Work
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Extg Sq Ft F j New/Added Sq Ft �� Total Sq Ft
XNew F7 Add F_ Alter r` Demo
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Floor
Suite No
# Units
Owner's E-mail Address
Ire _ K 5/ ul
Valuation $ �6-cDo -
It Stories
F7 3. Owner's Name Last
First F --
Owner's Address
Owner's E-mail Address
City --
State F Zip �— Telephoned
4. ArchitectiDesigner's Name Last F— ;First F_Lic. No. r--
Architect/Designer's Address
Architect/Designer's E-mail Address -
City �—.,.. --.
StateF Zip —i Telephone` - -
5. Engineer's Name Last F
First Lic No.
Engineer's Address
- -
Engineer's E-mail Address
City �— -.. -
State Zip r_—. TelephoneF— -. --......... .....
C6. Contractor's Name Last C LIMX First 1 �� Lic. No, Rc d ypclass C- a
ontractor's Address
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Contractor's E-mail Address
2_/'L—
Cityl��r�L`
State Zip (�� Tet ne 23/7
OFFICE USE ONLY
'1 /� , ,�1/,�i I PERMIT NO,
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $