HomeMy WebLinkAboutF2019-0520 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division t� Loll - OS. Zo
Please print 3 copies 1'
Associated Building Permit # (— i Fire Sprinkler F_j Fire Alarm rl Fire Misc
1. Project Address (Not mailing address) Floor No
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1109 Q1c�u. 1741 Svv_ �—
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Tenant Name . -a 1 cle. (. n ft #Units
2. Description of Work
Owner's E-mail Address
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F- 4. Architect/Designer's Name Last r--
Extg Sq Ft � New/Added Sq Ft �—� Total Sq Ft �--
Valuation $ 5j CIO U
New F_ Add F_ Alter F_ Demo
#Stories
Check Appropriate Box for Applicant/Notification
F7 3. Owner's Name
Last ��� �,�`
First F ) v,, i
Owner's Address
Owner's E-mail Address
City F—_—
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Zip Telephone
F- 4. Architect/Designer's Name Last r--
First F_ Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I....... _.
_._' State F—..
zipI Telephone�_�____I.
(- S. Engineer's Name
Last F
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First
___. Lic No,
Engineer's Address
Engineer's E-mail Address
City F—
State �' State I----
Zip r—i Telephone[ ---
contractor's Name Last
�� First F�---� Lic. No. ' p37 SZ -7 Class C °-d
I LJ�►e I E.raty
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Contractor's Address
Contractor's E-mail Address
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State Cd,
Zip( `r10.(6. Telephone [�7,6 3;1"7-g6V-
OFFICE USE ONLY
PERMIT NO. Oyz_
TYPE OF CONSTRUCTION
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PLAN CHECK NO. �l�vl tlJ ayi
OCCUPANCY - GROUP
PLAN CHECK FEE $
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