HomeMy WebLinkAboutF2019-0451 - Permit Application2-A N
Worksheet for Fire Permit Applicatio )p)
Cit of Newport Beach - BuildingDivision
Please print 3 copies n�f zo A c popY.
Associated Building Permit #( ' , ire Sprinkler Fire Alarm r ;Fire isc I
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name-.'..�Y--....A-r4 ---.. C1 C/zLS. - C� GJ,3 F#Units
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2. Description of Work
Owner's -mail Address
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Extg Sq Ft�_ I New/Added Sq Ft �Total S Ft F--',
Valuation$ CO�o�
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17 New F_ Add 5After f— Demo
# Stories F
Check Appropriate Box for Applicant/Notification
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F7 3. Owner's Name
Last C ,l
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Owner's Address
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Owner's -mail Address
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City._..State
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Zip Telephone(
4. Arch itecUDesigner's
Name Last F_
! First F--Lic No. F--
Architect/Designees Address
Architect/Designer's E-mail Address
City
State
Zip F_ TeleRhoneF
F 5. Engineer's Name
Last
First ,' Lic. No, r
Engineer's Address
Engineer's E-mail Address,'•
City
State r--
Zip F__ Telephone__.__
6. Contractor's Name
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Last 111 x � / First— _ Lic. N/o, ff Y/
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Contractor's Address
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Contractor's E-mail Address y -w ES..
City F�(?-,
State
Zip �za', Telephone L j �3
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OFFICE USE ONLY
PERMIT NO.
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TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $