HomeMy WebLinkAboutF2019-0166 - Permit ApplicationPrint Form
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Associated Building Permit #
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Worksheet for Fire Permit Appli�`,��-}.lon o� m
City of Newport Beach - Building DivisionM hiq 6K,, g
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[k Fire Sprinkler F- Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
�� 36 if �id0 Nay
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Tenant Name # Units
2. Description of Work
City
hie �pn'41AIs Lr 5F9 (5y kead5) _
Use
Extg Sq Ft New/Added Sq Ft 'Total Sq Ft
Valuation$ 75od
Architect/Designer's E-mail Address
# Stories 12
[_ New Add F_Alter r Demo
gSem h �
Check Appropriate Box for Applicant/Notification
[— 3. Owner's Name Last
First F_
Owner's Address
Owner's E-mail Address
City
State f — Zip Telephoned'
F_ 4. Architect/Designer's Name
Last I b' 0 First J� V11 Lic. No. f
Architect/Designer's Address
Architect/Designer's E-mail Address
5-Z6 IV S60a e Alva
,, rle �a�cl sSC� �r iar`l. cam
City 00 ccovikal
State CH Zip 9171 Telephone "67N
/
j— 5. Engineer's Name Last
First Lic. No. F
Engineer's Address
Engineer's E-mail Address
City I
State Zip F_ TelephoneF_
6. Contractor's Name Last G Ire VaY� 50n? kilo, First I� Lic. No. wg1 Class'
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Contractors Address
Contractor's E-mail Address
f5 3 VIG�//a''fr/R Ave
!lam vG(!?7�S�GOII�tIIr� cor"
City )p � l�kfQ
State C Zip 9(lZYj( Telephone`(//)3/9-o jy
OFFICE USE ONLY
o�3D PERMIT NO. `Z'• (� S�
TYPE OF CONSTRUCTION
` PLAN CHECK NO. 1� 2 c7L
OCCUPANCY -GROUP
33 a PLAN CHECK FEE $
2.-