HomeMy WebLinkAboutF2019-0421 - Permit ApplicationI —0421
Worksheet for Fire Permit Application
City of Newport Beach - Building Division Z�� S
Please print 3 copies /LO `<�`oar•P
Associated Building Permit # �— Fire Sprinkler j Fire Alarm ( Fire Misc
1. Project Address (Not mailing address) Floor Suite No
!First---
Tenant Name (—_—_--` j # Units
2. Description of Work
City
StateZip F— Telephone
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�I V�e--S�ri✓I �C�ers - For J FI� �.-�3 s'lecic�s,
__. _.... -.1
Extg Sq Ft New/Added Sq Ft --F--7
Total Sq Ft
Valuation $ 10/000__--_i
F-, New r—Add F_ Alter (` Demo
# Stories I L
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last--
!First---
Owner's Address
Owner's E-mail Address
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City
StateZip F— Telephone
F_ 4. ArchitectfDesigner's Name Last
VI Q First JQ Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
5 N S�IAd Gait_- �V�
City 1454
r� ✓ar 55 gflvd, ovt
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State C/ Zip -I i7gr7.- .. _. , Telephone (7iy) G.'ee
F` 5. Engineer's Name Last
First F Lic. No. ��—
Engineer's Address
Engineer's E-mail Address
CityA
State�zipF Telephone—(----- - -
1776. Contractor's Name Last Ua✓�% S'p f��[,<VFirstr_ -__ Lic. No. j9Z0oz Class Gro
Contractors
Contractors E-mail Address
�Address
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_ I rC' UG�r _S`70 (MRI F con-7city
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State C— Zip .R/ I QZ ('ra....... Telephone (3fa _01T
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OFFICE USE ONLY PERMIT NO...!
1 0 1
TYPE OF CONSTRUCTION _
(� PLAN CHECK NO. ZvI�
OCCUPANCY - GROUP
PLAN CHECK FEE $