HomeMy WebLinkAboutF2019-0026 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division O 126 �ZOjq
Please print 3 copies
I
Associated Building Permit# ` ( Fire Sprinkler L Fire Alarm r Fire Misc
1. Project Address (Not rn ' ress) Floor Suite No
lot
Tenant Name #Units
2 Description of Work
use I-
NEPA u �0 s�,r�LN — -
Extg Sq Ft F-- New/Added Sq Ft -; Total Sq Ft F
Valuation $ 1,
City--
State F
�ec �(
New r Add F- Alter F- Demo Lii
# Stories
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name
Last l �rrun �c L_
First
Owner's Address
Owner's E-mail Address
City--
State F
Zip F Telephone
F 4. Architect/Designer's Name Last
First F_ Lic. No.
Architect/Designees Address
w>.,.
Architect/Designer's E-mail Address
city
State F_
Zip F_ TelephoneF-
F 5. Engineer's Name
Last
First Lic. No.
Engineer's Address
r-
Engineer's E-mail Address
City
State r
Zip F - Telephone
F 6. Contractor's Name Last First �.��� Lic.No.07�OUClass��
Contractors
Contractor's E-mail Address
`Address
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State CR...
Zipl-1��ji.._ Telephone�A7G'..`37A
OFFICE USE ONLY
1l// PERMIT NO.
TYPE OF CONSTRUCTION
i PLAN CHECK NO.
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OCCUPANCY- GROUP
PLAN CHECK FEE $