HomeMy WebLinkAboutF2019-0647 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies F u t cA -DU4-1 p-1
Associated Building Permit # I--_-- �f Fire Sprinkler F_j Fire Alarm rJ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name 60 `d � �/ I #Units
2. Description of Work
City—
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Use _-
Extg Sq FtNew/Added Sq Ft F —71 Total Sq Ft I—_I
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Valuation $
Name Last First Lic. No.
# Stories
F,i New F_ Add F_ Alter r Demo
City
Check Appropriate Box for Applicant/Notification
F-1 3. Owner's Name
Last First--',
Owner's Address
Owner's E-mail Address
City—
State—; Zip F---- Telephoned
4. ArchitecVDesigner's
Name Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State—; Zip ; TelephoneF�
r; 5. Engineer's Name
Last First Lic No.
Engineer's Address
Engineer's E-mail Address
City
State f ---: Zip Telephone— _
r 6. Contractor's Name
Last ��YC; K j fasS t First F_Lic No. 173A'2[' le•
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Contractor's Address
_3f'Class
Contractor's E-mail Address'�"'"
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city �✓'-.
7 State Zip 174 Z+ . TelephoneFNY )35 %_,B+Ji
OFFICE USE ONLY
ql PERMIT NO. LQ 0Lc-(+-1 .
TYPE OF CONSTRUCTION
PLAN CHECK NO. )—n 15'2.0 4
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OCCUPANCY- GROUP
PLAN CHECK FEE $