HomeMy WebLinkAboutF2020-0204 - Permit Application (2)Worksheet for Fire Permit Application
PriClt R6ttr ;n. City of Newport Beach - Building Division
Please print 3 copies New w 6 vn i t- - I
Associated Building Permit C<Fire Sprinkler r Fire Alarm
ri Fire Misc
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1. Project Address (Not mailing address) Floor Suite No
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Tenant Name O # Units
2. Description of Work
Use Oes;detee
Owner's E-mail Address
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Extg Sq Ft �— New/Added Sq Ft c� Total Sq Ft 7��
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Valuation $ -7,000
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New r Addr Alter r' Demo
#Stories
Check Appropriate Box for Applicant/Notification
r; 3. Owner's Name Last
JFirst
Owner's Address
Owner's E-mail Address
City
State �—
Zip F_ Telephoned
r', 4. Architect/Designer's Name Last
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FirstI, Lic. No.
-
Architect/Designer's Address
Architect/Designees E-mail Address
City
State
Zip Telephone—
[; 5. Engineer's Name Last
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First—, Lic. No.
-
Engineer's Address
Engineer's E-mail Address
City
State
Zip Telephone—
Contractor's Name Last �YZ��N l (O�, First im ��r� Lic. No. �O 3-162.1 Class L 1�
Contractor's Address
Contractor's E-mail Address
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Zip 1 �t7 Telephone�y�j"
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OFFICE USE ONLY
PERMIT NO. ZL 0 O
TYPE OF CONSTRUCTION
PLAN CHECK NO. U
OCCUPANCY - GROUP
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PLAN CHECK FEE $
026
CITY OF NEWPORT BEACH Date:
Permit Tech:
COMMUNITY DEVELOPMENT DEPARTMENT
PLAN SUBMITTAL FORM
Print Name• Z44 O e
Signature:
❑ Pick-up Plans
I❑ Submitting Plans
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Phone #:
Email:
�... r .1—n wl nevision mumoer Number of Plan Name each document i.e., permit
Sets or application, plans, structural calcs, soil
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Payment Method
Payment can be made by credit card via phone at (949) 718-1888.
PAYMENTS MUST BE MADE AFTER 48 HOURS OF SUBMITTAL DUE TO QUARANTINE OF PLANS