HomeMy WebLinkAboutF2019-0351 - Permit ApplicationPr' \CA -QHS\ Worksheet for Fire Permit Applicaon
City of Newport Beach - Building Division "
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Associated Building Permit F_ Fire Sprinkler F_FireAlarm L-FireMisc
1. Project Address (Not mailing address) Floor Suite No
160T AVO( it AVE._nlit—vUr PT 43W# 0A 926(6
4Units
Tenant Name Cobl �W�at2T Dlh�nlos?�� Cr -4 �
2. Descriptions of Work
Owner's Address
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Valuation$
Extg Sq Ft New/Added Sq Ft Total Sq Ft
Zip_ Telephone
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Lic.No.
Check Appropriate Box for Applicant/Notification
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F7, 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
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State
Zip_ Telephone
(-I 4.Architectfesigner's ame Last
I First
Lic.No.
Archltect/Deslgner's Address
Architect/Design s E-mail E
City
StateZip
Telephoned
(-'. 5. Engineer's Name Last
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Lic No.
Engineer's Address
Engineer's E-mail Address
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State F
Zip Telephone�—
. Contractor's Name Last Il jZa-CPJIAM _
First�� Lic.No. �D/�Cy� Class ctri
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Contractor's Address
Contractor's E-mail Address
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City ��'l��""��-f'a..1- _
State
Zip Telephone
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
{1n 1q/O/PLAN CHECK FEE$