HomeMy WebLinkAboutF2019-0260 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies — 1_ Z® I C4 02 (9 0
Associated Building Permit r Fire Sprinkler ri Fire Alarm r) Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
—
First
Owner's Address
Tenant Name
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# Units
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2. Description of Work
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Use
Extg Sq Ft
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New/Added Sq Ft l Total Sq Ft F
Valuation $
-
New F_
Add F_ Alter r Demo
# Stories
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
ISL t N `
—
First
Owner's Address
Owner's E-mail Address
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11
City"U L__W � ,� Pal State �
Zip F TelephoneF�
4. ArchitecUDesigner's Name
Last �—
FirstF
Lic, No F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State�--.,
Zip r----',� Telephone
1*7 5. Engineer's Name Last
�—
First --
Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State
Zip Telephone
F76. Contractor's Name Last
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First �1 14s4p�p—, Lic. No((((((�l i t 7L1 Class
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Contractor's Address
Contractor's E-mail Address
- —) 1 III-S_ts
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Cityr�.,
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I ?_o i p Telephone(�""7 �9D.�'�
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OFFICE USE ONLY
Y��� �l� t PERMIT NO. �%?NLGI
6?1-0
TYPE OF CONSTRUCTION
uli o Mjq PLAN CHECK NO. (��I
OCCUPANCY - GROUP
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0 PLAN CHECK FEE $