HomeMy WebLinkAboutF2019-0534 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division o
Please print 3 copies
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Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name UJgcgn __.
2. Description of Work
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Owners E-mail Address
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Extg Sq Ft New/Added Sq FtF_, Total Sq Ft �'
Valuation $
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# Stories
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Architect/Designer's E-mail Address
Check Appropriate Box for Applicant/Notification
3. Owner's NameLast
First F—
Owner's Address
Owners E-mail Address
city
city
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: State Zip F7777 Telephoner—
F_ 4. Architect/Designer's Name Last First Lc No:
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Architect/Designees Address
Architect/Designer's E-mail Address
City
State F Zip F— TelephoneF—
f- 5. Engineer's Name
Last --QN, First. Lic. No.l
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Engineer's Address
E-mail Address
Engineer's E-mail
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F_ 6. Contractor's Name Last �� FirstF7T _ Lic. No. 7Z39� Class
Contractors Address
Contractors E-mail Address
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OFFICE USE ONLY
ll J :,;i) PERMIT NO.
TYPE OF CONSTRUCTION
`r 69 PLAN CHECK NO.
OCCUPANCY- GROUP
a l PLAN CHECK FEE $
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