HomeMy WebLinkAboutF2019-0390 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # - ❑ Fire Sprinkler
1. Project Address (Not
Tenant Name
ft [( 'P/
Fire Alarm F. Fire Misc
Floor Suite No
P.
# Units F
2. Description of Work
��y i Use
—T Valuation $ 4 �0i
Extg Sq Ft � New/Added Sq Ft F_ Total
Total Sq Ft _ 1 _-- - -
# Stories
F_ New [_ Add F- Alter r Demo
Check Appropriate Box for Applicant/Notification
(- 3. Owner's Name Last
First �—
Owner's Address
Owner's E-mail Address
City State F_
Zip F777 Telephoned
4. Architect/Designer's Name Last V I First Lic. No.
_- I
Architect/Designer's Address
— -
Architect/`D'essigner's E-mail Address
- �ry,r ' ✓II-�l�rtPy �(��'�i��'I DIW�I�'/�t
City - `rV� State i.
Zip r.. Telephone'
r 5. Engineer's Name Last
First Lic. Nof—
Engineer's Address
Engineer's E-mail Address
City State
Zip F Telephone
6. Contractor's Name Lastl3avlh
First ICI r' ► u'1� I t Lic No. Class-
--_. -------
aq!wContractor's Address A\fl kontractor's E-mail Address
---
;! I Md ca M4J�U blry'S -"A
City e �-
Zip 14/ Telephone
I
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $