HomeMy WebLinkAboutF2019-0006 - Permit ApplicationWorksheet for Fire Permit App'IC
Please print 3 ,��
copies l C�
�ilY01Newport Bea
atlon Ji
ch- Building Division
Associated Building permit #
{
1. Project Address I Fire Sprinkler C_. I -'$" L
(Not mailin (! Fire Alarm (', Fire
g address) Misc
Tenant Name Floor Suite Nc
�.
2. Descri
ption of Work J— —_
L #Units
. , ^fi' �l
Ext9 Sq Ft �-- Use
New/Added Sq Ft—�'-. q Ft ��-
�- New -- Total SValuation $
P --Add r Alter 1 001
Check A Demo
pproPr(ate BoX for gpp)(ca�bNotification #Stories
l
3- Owner's Name Last
Owner's Address
7L9 S
Owner's
mail Address
City
Last State
L 4. Architect/ Zips J �S I-- -
Designer's N 7elephonei -- -
ame r
Architect/Designer'sAddress ----
First
j J )
Architect/DesignersLic. No. i
't
Qty ; E-mail Address _. --_.
�- - -
--'-- - State
-._._ Zip --
1 _ 5. Engineer's Namelast i Telephone,[—
Engineer's Address-- --
First
_ E-mail City Engineer's AddLic. No.
-. -.. _. ress I -..
_. ___... _... State lf�
Contractor's Name - zip~' r a f
Telephoner
Last I k��4J
Contractor'
s Addst
if C_
/ Lic. No. r�/y Class
`
L --n'' %/ 1cp ' f•� VL/ contractors E-mailAddress /
Qty 10; c .
11 ,.
l I State l,�C E✓I� �` SJCt� `i%`
p �•Cu
OFFICE USE ONLV Z Telephone,'C�L/C t
PE
TYPE OF CONSTRUCTION ., i/33 t/ �
OCCUPANCY- GROUP RMIT NO. ✓"„ ? ;`:
JL4.%
PLAN CHECK NO. of
r✓l
PLAN CHECK FEE $ (