HomeMy WebLinkAboutF2019-0504 - Permit ApplicationWorksheet for Fire Permit Application q609102i",City of Newport Beach - Building Division Y'iPlease print 3 copies
Associated Building Permit# �— j"a` Fire Sprinkler r', Fire Alarm r! Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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F--___.—_— # Units
Tenant Name .... III
2. Description of Work
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City
Use
Zip-- Telephone
r' 4. Architect/Designer's Name
Last First Fry Lic. No.
Architect/Designer's Address
Valuation $j:,i,,
Extg Sq Ft (—� New/Added Sq Ft I.. Total Sq Ft F-
City
'. State ��,
# Stories
New r: Add �; Alter F -Demo
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Check Appropriate Box for Applicant/Notification
F- 3. Owner's Name Last `—
First F
Owner's Address
Owner's E-mail Address
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City
State �—!.,
Zip-- Telephone
r' 4. Architect/Designer's Name
Last First Fry Lic. No.
Architect/Designer's Address
Architect/Designers E-mail Address
City
'. State ��,
Zip F_. Telephoned
F_ 5. Engineer's Name Last
,� / L.
First �` >>o_ Lic No.
Engineer's Address
Engineer's E-mail Address
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X'�,
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City j �'1 _�i1 r,,�iq 'L.
State
Zip 1// /rT4_ Telephoner
F17/64
6. Contractor's Name Last {� I
t.� First --L,'. Lic No. x '? Class
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Contractor's Address
Contractor's E-mail Address
City I �c'll /?JV)t�.
State
zip �1(-7„ Telephone[/�`J
PERMIT NO.
OFFICE USE ONLY
TYPE OF CONSTRUCTION —
PLAN CHECK NO. C1 7LLO�
OCCUPANCY - GROUP
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PLAN CHECK FEE $
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