HomeMy WebLinkAboutF2019-0478 - Permit ApplicationZDL�' D1411 Worksheet for Fire Permit Application(910,
City of Newport Beach - Building Division
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Associated Building ?
g Permit# t,'[�C'I cJ _ Z2 (• 9 1 F Fire Sprinkler ❑Fire Alarm [71 Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name C.c.,C� �e+iL'. _
2. Description of Work
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Owner's E-mail Address ;,,,J- -("C> P1
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ZIP Telephone �G"% 52�- L� 7,4I c
Extg Sq Ft /2i oa,;, New/Added Sq Ft f ` '�� Total Sq. Ft R
aluation $ v
# Stories
F' New F_ Add Iter F_ Demo
Check Appropriate Box for Applicant/Notification
F- 3. Owner's Name Last f
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FirstG . c) -r-
Owner's Address
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Owner's E-mail Address ;,,,J- -("C> P1
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city State
ZIP Telephone �G"% 52�- L� 7,4I c
[ 4. Architect/Designer's Name Last �1 r First Lic. No.
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Architect/Designer's Address
Architect/Designer's E-mail Address
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City �, • State
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,S.Engineer's Name Last�
First��, Lic No jh�/a3
Engineer's Address
Engineer's E-mail E-m-aillAAddress
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61 P-/�iW L� ✓i/iusPx(, , 0tr
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Zip 100 50)__. Telephone1.i/ '" 15UI) - (qq(1
)-•''•.. 6. Contractor's Name Last v,•✓ d v
First r------,. Lic. No. K3 off Class. FU_ /ktB'
Contractor's Address
Contractor's E-mail Address
City (��------ State
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Zip Telephone F1.5..- sb p _ rLro
OFFICE USE ONLY
TYPE OF CONSTRUCTION
PERMIT NO, V�le V 1C.0
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $
640— P Kvfh I