HomeMy WebLinkAboutF2019-0060 - Permit Application�PoAr
Worksheet for Fire Permit Application o2Lfq.;ojq
City of Newport Beach - Building Division a
Please print 3 copies F.2019- 0060
Associated Building Permit # I ( F-1 Fire Sprinkler (i Fire Alarm j--; Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name S G,M`J C. >tb # Units I
III
2. Description of Work
Use
Extg Sq Ft l l New/Added Sq Ft �� Total Sq FtF�
Valuation $
Add r Alter F-#
Demo
Stories
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Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
First F
Owner's Address
Owner's E-mail Address
City _',�
StateI
Zip F Telephoned
4. Architect/Designer's Name Last
( First Lic. No. —'
Architect/Designer's Address
Architect/Designer's E-mail Address
i
City �—
State—,
Zip --j Telephone
[7 5. Engineer's Name Last
First F— Lic. No.
Engineer's Address
Engineer's E-mail Address
City �—
StateZip
—Telephone(---�
', 6. Contractor's Name Last �C j First — Lic. No. Class
Contractor's Address
Contractor's E-mail 4dres
/
City �a.���
State
Zip TelephoneR
OFFICE USE ONLY
PERMIT NO.2dIcI 00�
TYPE OF CONSTRUCTION _
PLAN CHECK NO. 9AIq
OCCUPANCY- GROUP
PLAN CHECK FEE $