HomeMy WebLinkAboutF2016-0636 - Permit Applicationlnt Form;
Please print 3 copies
d�65, 2016 f 2oi - 003o I 1 0-
372,of 051(o Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Associated Building Permit # I X 2,01(o .' Z 5 La, gr. Fire Sprinkler r' Fire Alarm (T'; Fire Misc
1. Project Address (Not mailing address) Floor Suite No
ZG�tDYO # Units
Tenant Name
1-Cr?-C? j�S �?L"'17{-�- He- Off 1 n/11
2. Description of Work
Use
Valuation
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I Mo is
$
6P fitories
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2 ,'6 1--1
41-
a o^ n'm C3 Sec; 4-Act Vol c_ch .... .. _... _.._. _.I.
Extg Sq Ft
I- New
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r 773 st,
fl! Add
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New/Added Sq Ft) i Total Sq Ft
I Alter ram: Demo
)- 7.73 f ii-
Check Appropriate Box for Applicant/Notification
x
FT 3. Owner's Name Last
Owner's Address
[ ' First)
Owner's E-mail Address
City
r
1 State
Zip 1
,., Telephone)
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IT 4.
Architect/Designer's
ArchitectlDesigner's Name Last
Address
i First)
Architect/Designer's
Lic. No.
E-mail Address
L
I
I gT_3a0 CP 55 /b
City
„_.., I State
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i �, Zip,
Telephone) )
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1°
5.
Engineer's
Engineer's Name Last
Address `-.„
I
First
Engineer's
' Lic. No.�
E-mail Address
City
I State
j Zip
I i Telephone)
R'.6.Contractor's Name Last i!gwZ I
Contractor's Address So✓tliwc�s� 'F;re (a) G o�
First) ?Dr,—,".
Contractor's E-mail Address
Lic. No.
Jydt73Class
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City)
Mohl'ov.c,_ j. State
Zip
I_. 9 T 1 50._._
TelephoneVCo2Ce) 39?,.Oc73y.
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OFFICE USE ONLY PERMIT NO.
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"-76✓C�' 2-Mk)
TYPE OF CONSTRUCTION PLAN CHECK NO
OCCUPANCY GROUP
- PLAN CHECK FEE $