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HomeMy WebLinkAboutF2019-0265 - Permit ApplicationWorksheet for Fire Permit Application lao, City of Newport Beach - Building Department Please print 3 copies �7_o �GA -07-6CD Fire Sprinkler r- Fire Alarm F- Fire Misc 1. Project Address (Not mailing address) Floor OfA -16-C-6. . . ....... . .. ........ Tenant Name (if Applicable) 2. Description of Work If Sprinkler How Many Heads? �07 .1.1 1 1 ­,""..", .. .. ...... 11.111.1111.1 1 111 . ... ...... ... . 0 41t m✓ Check Appropriate Box for Applicant/Notification Information # of Units (if Residential) 3. Owner's Name Last177777 1 First .. ........ ...... ... ... .......... .... .... ... ... .. .- _: Use 0 Valuation $7'W Suite 77 No 177 # Stories 17;�� Owner's Address Owner's E-mail Address F-77 ..... ...... .. .. .... ..... . . City State F Zip F777 TelephoneF77777 4. Architect/Designer's Name Last First Lic. No. Architect/Designer's Address Architect/Designer's E-mail Address .... .. .. .. . ... .. F� .. .. ..... City State zip Telephone F ri 5. Engineer's Name Last First Lic. No. ........... . ... ... ................... F77777 ..,,,z Engineer's Address Engineer's E-mail Address ........ . ................ .... ... .......... .. Mile, CityState Zip Telephone ... .. ........ .......... . .... . ... .. ............ . F777 ... ........ .. .. '6. Contractor's Name Last .... ...... .. .... .. .... .. .... First F77777 Lic. No. F?qlf i4e, a'ss Fc-./,( . . ...... Contractors Address Contractor's E-mail Address 0 3�m City State zip Telephone 1111 v.lF ........... P OFFICE USE ONLY PERMIT NO. 0 Y -V PLAN CHECK NO. JA Rev 1118107 Associated Building Permit # PLAN CHECK FEE $