HomeMy WebLinkAboutF2019-0316 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies F Zo I� U 31
Associated Building Permit # (----� Fire Sprinkler F(—; Fire Alarm [7, Fire Misc
1. Project Address (Not mailing address) Floor Suite No
--#
Tenant Name Units
2. Description of Work
I
Owner's E-mail Address -
Use
�'. State
Telephoned
4. Architect/Designer's Name
E_M/g Sq Ft �- New/Added Sq Ft Total Sq Ft —���
Valuation $ —I r ZO D
----
/New
# Stories
F/Add r-, Alter F_ Demo
State--...
Check Appropriate Box for Applicant/Notification
F' 3. Owner's Name Last
First I
Owner's Address
I
Owner's E-mail Address -
City �...
�'. State
Telephoned
4. Architect/Designer's Name
Last — First r-- Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State--...
Zip Telephoned
5. Engineer's Name Last
Aallid
I
First �— Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State _
Zip �.._ Telephoned
F6. Contractor's Name Last F4.4— " First F5r,tgr� Lic. No. Iry[.j uo Classf�I&
Contractor's Address
S. X11 e
( S
Contractor's E-mail Address
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State C>L}
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Zi ��`��, Tele ne� 6tt.� � C( ' 0
OFFICE USE ONLY
PERMIT NO, Jul 03
TYPE OF CONSTRUCTION
--Llc)/
PLAN CHECK NO. IJ F?
OCCUPANCY- GROUP
PLAN CHECK FEE $