HomeMy WebLinkAboutF2019-0532 - Permit ApplicationWorksheet for Fire Permit Application
R� 66,�,Iwyp)�of Newport Beach -Building DivisionPlease print 3 copies_
Associated Building Permit # -! Fire Sprinkler (-••'•. Fire Alarm 7' Fire Misc
1. Project Address (Not mailing address) Floor Suite No
First—,
Tenant Name # Units F
Owner's E-mail Address -
2. Description of Work
Telephone—
Use
First F_ Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City State Zip
Valuation $
Extg Sq Ft F_ New/Added Sq Ft Total Sq Ft
----- -
Engineer's Address
# Stories F
r -,New (_ Add F -Alter F -Demo
Telephoned
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
First—,
Owner's Address
Owner's E-mail Address -
City F—. -, -.--. State F777 Zip
Telephone—
[- 4. Architect/Designer's Name Last
First F_ Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City State Zip
F--- Telephone�v
[- 5. Engineer's Name Last
FirstF_Lic No. � --.
Engineer's Address
Engineer's E-mail Address
City State Zip
Telephoned
r'. 6. Contractor's Name Last C\
First �^� �Lic. No. lass [EN)
Contractor's Address
Contractor's E-mail A s
\\Cn _
city State �� �� - State F�� _ Zip
Telephonehv-A._vy\
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OFFICE USE ONLY
PERMIT NO. L �j
CHECK NO. G
TYPE OF CONSTRUCTION
PLAN {
OCCUPANCY- GROUP
PLAN CHECK FEE $