HomeMy WebLinkAboutF2019-0112 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # ! j Fire Sprinklerj Fire Alarms Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name „-..- -. ---.- _.-.... -..,-......I ` # Units I
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2. Description of Work
Owner's E-mail Address
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Extg Sq Ft �— New/Added S Ft Total Sq Ft
Valuation $
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New F_ Add f- Alter F_ Demo
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Architect/Designees E-mail Address
Check Appropriate Box for Applicant/Notification
F 3. Owner's Name Last
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Owner's Address
Owner's E-mail Address
City --,-.
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Zip -. Telephoned'...
F_ 4. Architect/Designer's Name Last
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Architect/Designer's Address
Architect/Designees E-mail Address
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Zip �(%
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r 5. Engineer's Name Last
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First . Lic. No. F
Engineer's Address
Engineer's E-mail Address
City .,
_ State
Zip r—i Telephone
j 6. Contractor's Name Last f�ETJ�dZSd
First l.3aeI-dA) Lic No. %vz7✓Y Class L -I
Contractor's Address
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Contractor's E-mail Address
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Zip Q/Gd _.-.- Telephone s3) U�—,6716
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OFF/CE USE ONLY
� p 2,6 L PERMIT NO.
TYPE OF CONSTRUCTION
�C�r PLAN CHECK NO. QW
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OCCUPANCY - GROUP
PLAN CHECK FEE $