HomeMy WebLinkAboutF2019-0302 - Permit ApplicationWorksheet for Fire Permit Application U6,14Print Form City of Newport Beach -Building Division������ZPlease print 3 copies
Associated Building Permit #
Fire Sprinkler F_ Fire Alarm
F Fire Misc
1. Project Address (Not mailing address) Floor Suite No
16yLl _r a,axy D
Tenant Name # Units
D��_e� N, _x
2. Description of Work
Owner's E-mail Address
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Valuation $ 8 Q n
Extg Sq Ft '' New/Added Sq Ft+� Total Sq Ft
State F_ Zip [— Telephoned. -.---.---
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F- New r Add I-- Alter rX Demo
F
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name Last
First F
Owner's Address
Owner's E-mail Address
City
State F_ Zip [— Telephoned. -.---.---
r 4. Arch itect/Designer's Name
Last First F Lic. No.
F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State ��' Zip F_ Telephone
r 5. Engineer's Name Last
�' FirstF_Lic. No.
F—,
Engineer's Address
Engineer's E-mail Address
City
State I � Zip F_ Telephones',
r6.Contractor's Name Last JC 91%ano First �c;,f� Lic. No. X15"5�$ Class L--j�
Contractor's Address
Contractor's E-mail Address
City Loi F''a%�
State �R Zip ?WJ/c,,Jd Telephone 9y�7��{iG,G
PERMIT NO.
D
OFFICE USE ONLY
�( U _ 'tom-
S
x
TYPE OF CONSTRUCTION
v t PLAN CHECK NO. l�
OCCUPANCY- GROUP
C( �j^� a O PLAN CHECK FEE $