HomeMy WebLinkAboutF2019-0484 - Permit ApplicationPrint Form Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit #10 • I" Fire Sprinkler I— Fire Alarm
1. Project Address (Not mailing address)
Tenant Name
2- nesrrinfinn of Wnrk
Extg Sq Ft F—
NewlAdded Sq Ft F_
New F Add F- Alter F Demo
Check Appropriate Box for Applicant/Notification ,
Total Sq Ft
C
We Misc
Floor
Suite No
#Units
Use
ValuationValuation $ )0121W
# Stories
r— 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City [ State
F
Zip r—_--- TelephoneF�
f 4. Architect/Designer's Name Last
i First F---- Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �— State
Zip Telephone
r 5. Engineer's Name Last F
First F_Lic. No.
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephone[-
6. Contractor's Name Last h
First - /' Lic No. Fs4q"classF—edo
Contractor's Address
Contractor's E-mail Address
C2,750
r
vccc� �aw-�a `r ,i �c - coo?
City ��rG� State
CA
Zip / $ Telephone '7/#{ 577- 5 p
OFFICE USE ONLY
PERMIT NO. tpl- C •oak
TYPE OF CONSTRUCTION
PLAN CHECK NO. i QW • ���
OCCUPANCY - GROUP
PLAN CHECK FEE $