HomeMy WebLinkAboutF2019-0384 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division o
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Associated Building Permit# ��1 7 j Fire Sprinkler 1 j -j Fire Alarml (—! Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name # Units
2. Description of Work
Owner's Address
Use f
City �—
Extg Sq Ft New/Added Sq Ft F—i Total Sq Ft F
Valuation $
-
New F_ Add F_ Alter r Demo
# Stories
I
Last-- First
`
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
First F--',
Owner's Address
Owner's E-mail Address
City �—
State �—
Zip—',
Telephone
r 4. Arch itect/Designer's Name
Last-- First
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City) _...
State j�—_,
Zip Ir_-.__—�
Telep e
F_' 5. Engineer's Name Last
Fir
is No.
Engineer's Address
Eng eer' -mail Address
City �� ___..
StateF !'
ZiPF-1
Telephone'
F76. Contractor's Name Last if First
Lic. No. ro4%G Fclass(-- 4'—
Contractors Address
Contractor's E-mail Address
City � WFO^4^' / c
State GSC
Zip (W ?) ;.
Telephone Ql j IW
7'1
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP��
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D C—CA <
PLAN CHECK FEE $