HomeMy WebLinkAboutF2019-0409 - Permit ApplicationPrint Form Worksheet for Fire Permit Application
Z� ®1 , D v,,,City of Newport Beach - Building Division
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Associated Building Permit # k', Fire Sprinkler F_ Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
20
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Tenant Name
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# Units
2. Description of Work
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Valuation $�uL/
Extg Sq Ft
�� New/Added Sq Ft r Total Sq Ft
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# Stories F
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last�JQ+�lloplrC� Ma W�4
Owner's Address UM
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city 1pv„vr t State Zip' Telephone�� y I f C
F_ 4. Architect/Designer's Name Last I First Lic. No.
Architect/Designer's A�ddrreess�1t�/1 Architect/Designer's E-mail Address
City O (/ State ZipF2N5 Telephone 71q..2�3•(}%�j�Z3
F_ 5. Engineer's Name Last l IM � I First I/lU - Lic. No. ( -
Engineers Address I Engineer's E-mail Address
City State 1W Zip q K Telephone W
r- 6. Contractor's Name Last I VI V1 First I. J V I V L Lic. No. 4W (k ClassII 1 n
Contractor's Address Contractor's E-mail Address `(
City �I uln State — Zip �� Telephone Jj t X3 02/1 J Nt2_
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OFFICE USE ONLY�(�%7 a �� C7'✓�^ PERMIT NO. W 1 L
TYPE OF CONSTRUCTION xvil �(� � PLAN CHECK
OCCUPANCY - GROUP 117A.Ul PLAN CHECK FEE $