HomeMy WebLinkAboutF2019-0075 - Permit Applicationr2® !q 001S
Worksheet Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit xZ�j\Q� ZQ7 (' l�! Fire Sprinkler [Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
22
#Units
III
Tenant Name
2. Description of Work '7
Use
F_ 4. Arch itectlDesigner's Name Last
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Architect/Designers Address
Architect/Designer's E-mail Address
Valuation $
Extg Sq Ft New/Added Sq Ft Total Sq Ft Nr ca0o
ci 5. Engineer's Name Last
New F -Add [! Alter F -Demo
# Stories I
Engineers E-mail Address
City State
Check Appropriate Box for Applicant/Notification _
F-'3. Owner's Name Last
First
Owner's Address
Owners E-mail Address -
City _..- State
—.... Zip.. Telephone——;
F_ 4. Arch itectlDesigner's Name Last
First ' Lic. No. �
Architect/Designers Address
Architect/Designer's E-mail Address
City State
7—.. Zip F Telephoned
ci 5. Engineer's Name Last
First Lic. No. F
III
Engineers Address
Engineers E-mail Address
City State
�. Zip �— Telephone[—
J7 6. Contractor's Name Last �- _ First Ri+� _, - Lic. No. 553703 Class �,) (,
Contractors Address
Contractor's E-mail Address
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City NC-.kjflof% 6ext k State
l Zip _l L66o Telephone' 71�gg q
PERMIT NO.'LOt� ®�7�
OFFICE USE ONLY
- (Zo
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
o v i 2 -Cl PLAN CHECK FEE $