HomeMy WebLinkAboutF2019-0636 - Permit ApplicationWorksheet -for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit# [; Fire Sprinkler Fire Alarm Fire Misc
1. Project Address (Not mailing address)
Tenant Name
2. Descrintion of Work
vi �4,4)
t
E#g Sq Ft �� New/Added Sq Ft �� Total Sq Ft
New Add ❑ Alter Demo
Check Appropriate Box for Applicant/Notification
Floor Suite No
It Units
Use
Valuation$
It Stories 1y
[� 3. Owner's Name -Last o Pmr 7 rst
Owners Address Owner's E-mail Address
city "'L _)j State Zip Z(s L� Telephone
❑4. Architect/Designer's Name Last J First Lie, No.
ArchitecUDesigner's Address Architect/Designer's E-mail Address
City State Zip = Telephoned
5, Engineer's Name Last — `_ I First Z((/� Lic. No.�I
Engineer's Address Engineers E-mail Address LLLL
�I }
City GI'�is �-jQ� State Zip Telephone Gd SD� �,�GrO
[]5. Contractor's Name Last t
Lic No. �� Class —I
Contractor's Address Can c s)Ei bell Address
City _ _—J State J Zip L� Telephoned
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
PERMIT NO. r ' J-'
PLAN CHECK NO-
PLAN CHECK FEE $
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