HomeMy WebLinkAboutF2019-0281 - Permit ApplicationPrint Form N"' ••KT
Worksheet for Fire Permit Application 04
Please print 3 copies ow "
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City of Newport Beach -Building Division g
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Associated Buil i rmiFire Sprinkler F_ Fire Alarm i _ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name # Units
2. Description of Work
Use
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City
Valuation $
Extg Sq Ft F_ New/Added Sq Ft Total Sq Ft F
Last p First 0WW__Lic. No. f .-
-Demo
# Stories
rl, New F_Add i_ Alter F
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Check Appropriate Box for Applicant/Notification I
F_ 3. Owner's Name Last
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Owner's Address
l Owner's E-mail Address
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City
State Zip F_ Telephoned
[W 4. Arch itect/Designer's Name
Last p First 0WW__Lic. No. f .-
Architect/Designer's Address
Architect/Designer's E-mail Address
5z6' IV She yhe 41/42
71,
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City VVes CJ(/((ilR
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State Cee � Zip "ln I77e Telephone 0``0/0 .-at? �/
(- 5. Engineer's Name Last
,First F_, Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State I._ Zip Telephones
6. Contractor's Name Last'', QF�J ��l �(/✓d l�`First[ -.---............. Lic. No. Ft777)oZ ClassP
Contractor's Address
Contractor's E-mail Address
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State C.4 Zip %(%��o Telephone o/cf) v fO-al y
OFFICE USE ONLY
PERMIT NO. f4tp (q _� o Is�b(
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
ib PLAN CHECK FEE $