HomeMy WebLinkAboutF2020-0514 - Permit ApplicationWorksheet for fire Permit Application
City of Newport Beach - Building Division ZC Z,u. o S
Please print 3 copies f G4pppMr
Associated Building Permit # II n Fire Sprinkler 7 Fire Alarm F Fire Misc
t. Project Address (Not mailing address) Floor Suite No
( First
Tenant Name ��22 ' �� ` � N jl t/ C Wt- #Units Fs,'
2. Description of WorkU(�
Use
StateF Zip —, Telephone---
(-:4. Arch itectlDesig nor's Name Last
First Lic. No. --
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Extg Sq Ft I New/Added Sq Ft-� Total Sq Ft [�
Valuation $ 1� QV
i
� i New r Add °j`Sy Alter r, Demo
# Stories
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Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
( First
Owner's Address
Owner's E-mail Address
i
City
StateF Zip —, Telephone---
(-:4. Arch itectlDesig nor's Name Last
First Lic. No. --
Architect/Designer's Address
Architect/Designer's E-mail Address
City
I
State— Zip--,-� Tele hone)
F75. Engineer's NameLast
- First-- Lic. No.
Engineer's Address
Engineer's E-mail Address
City �—
State Zip f -i Telephonel— _--'
f-16.Contractor'sName Last [ First 5 �I, Lic.No.�` �]�j'Z.Class�
.,C_ , _ _ G) b
Contractor's Address
�w 631
Cit,M�wAU-J
State Ci{� Zit `\ q/ Telephone } 1
OFFICE USE ONLY
PERMIT NO. — OS
TYPE OF CONSTRUCTION —
1.07-U -C)!7) PLAN CHECK NO. �� N
OCCUPANCY - GROUPGbtol-
4132 PLAN CHECK FEE $