HomeMy WebLinkAboutF2020-0229 - Permit ApplicationWorksheet for fire Permit Application
r � 7/V— 07 1 City of Newport Beach - Building Division
Please print 3 copies T ��
Associated Building Permit # �— K Fire Sprinkler r Fire Alarm [7 Fire Misc
1. Project fAddress (``Not mailing address) Floor Suite No
Last �— — i First F
Tenant Name # Units
2. Description of Work
City
State Zip �— Telephone[
Use
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Extg Sq Ft F New/Added Sq Ft Total Sq Ft
Valuation
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[ j New r Add r Alter r Demo
# Stories Fz
Check Appropriate Box for Applicant/Notification
rl 3. Owner's Name
Last �— — i First F
Owner's Address
Owner's E-mail Address
I
City
State Zip �— Telephone[
174. Arch itectlDesigner'sName
Last V) First .)rr�j0 Lic.No.��
Architect/Designees Address
Architect/Designer's E-mail Address
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City I I�V�S-.� �d✓Ikvi
State Zip G�17� Telephone
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F7 5. Engineer's Name
Last First �— Lic. No.—'
Engineer's Address
- Engineer's E-mail Address
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City �— �', State Zip (-i TelephoneF— --
r 6. Contractor's Name
Last Var4.I..-S�2i- Vi � First r Lic. No. tf Class
Contractor's Address
Contractor's E-mail Address
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City )�
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State Zip Q Telephone 6
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OFFICE USE ONLY
PERMIT NO.
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TYPE OF CONSTRUCTION PLAN CHECK NO. V"l�5• �/
OCCUPANCY -GROUP nn PLAN CHECK FEE
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