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HomeMy WebLinkAboutF2019-0165 - Permit ApplicationWorksheet for Fire Permit Application" VHm Print Form 9 _ City of Newport Beach -Building Division Please print 3copies—U Ie)rD ox'' Associated Building Permit # F W Fire Sprinkler I— Fire Alarm F_ Fire Misc 1. Project Address (Not mailing address) Floor Suite No 1555 QCeavt _ 7— Imo.._ Tenant Name # Units 2.Description of Work City / J / R Fle SF(It til e r 7 _ SF9 (2q he,, 1,5) Use , _ Extg Sq Ft New/Added Sq Ft r — Total Sq Ft Valuation $ y) 0 eo Architect/Designer's E-mail Address # Stories F New r Add F_Alter r Demo City W 5{ cavroR State CA 7 Zip "I I! 10 Telephone (70)310 Check Appropriate Box for Applicant/Notification L.F.. ..4'.. F_ 3. Owner's Name Last First Owner's Address Owner's E-mail Address City State Zip F— Telephoned F_ 4. Architect/Designer's Name Last U0 ,. First �p h Lic. No. F Architect/Designer's Address Architect/Designer's E-mail Address 52� Al 3 �,uy r7 e lllep 1'v-�y(qrS15 9*171 60 City W 5{ cavroR State CA 7 Zip "I I! 10 Telephone (70)310 F_ 5. Engineer's Name Last First Lic. No. --- ----' Engineer's Address Engineer's E-mail Address City State Zip TelephoneF�, F_ 6. Contractor's Name Last I fr�rj (V rj nl j,t��r pr First l Lic. No. f f2ppz Class `{ . ,� d Y Contractor's Address Contractor's E-mail Address g5gl3 Vf,ddrra Ale )repe(r Ss c� Gi(??6i'1,1 tom City SvA Gots State �— Zip I gc/Zgtl Telephone(Z/y�3�o G7Fc / OFFICE USE ONLY (�, �� ©LSU/ PERMIT NO. TYPE OF CONSTRUCTION")V 3 PLAN CHECK NO. OCCUPANCY - GROUP ill PLAN CHECK FEE $