HomeMy WebLinkAboutF2019-0549 - Permit ApplicationWorksheet for Fire Permit Application
F2(919- O 5k9 City of Newport Beach - Building Division y
Please print 3 copies ��� ��' ✓ 5 ""°""
Associated Building Permit # r; Fire Sprinkler ( Fire Alarm Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
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Tenant Name
rj 1
Architect/DesigneCs E-mail Address'
#Units �.
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City �grrl A
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5. Engineer's Name
2. DescriptionofWork
Engineer's Address
Engineers E-mail Address
Use
State r Zip Telephoned---
C' S. Contractor's Name
Last H�� ; �� First Lic. No.Class 648E3 Z5
Contractors Address
Valuation $ 2000
Extg Sq Ft
�77
New/Added Sq Ft F_ Total Sq Ft �!:
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OFFICE USE ONLY
1 PERMIT NO.
TYPE OF CONSTRUCTION
# Stories F7
I New
F_ Add
[`••••.. Alter F_ Demo
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Check Appropriate Box for Applicant/Notification
3. Owners Name
Last V 6AsFra,0('+� h L, First 1
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Owner's Address
Owner's E-mail Address
loo W (&0 i�V�n� �Ni -- - --- -
aty (J"r RCa41 StateL'I Zip `�Z{p Telephone--
)` 4. Architect/Designer's Name Last NQ,M i }Do' First M j k Lic. No. g�3 855
Architect/Designees Address
Architect/DesigneCs E-mail Address'
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$4t lu3 ro Cr.{'io�l rn�tae.Ce� '
City �grrl A
-..- : State �—, Zip I 62_ Telephone qS/ 93
5. Engineer's Name
Last First7-77-7 Lic. No.
Engineer's Address
Engineers E-mail Address
City
State r Zip Telephoned---
C' S. Contractor's Name
Last H�� ; �� First Lic. No.Class 648E3 Z5
Contractors Address
Contractor's E-mail Address
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-City
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-... --: State C•1.- Zip 17..S�j2-. _ Tele�phoJne ry$I 3�� �6j
OFFICE USE ONLY
1 PERMIT NO.
TYPE OF CONSTRUCTION
�� � �� PLAN CHECK NO. 22GS 'elf' �Q1
OCCUPANCY -GROUP
�`�� PLAN CHECK FEE $