HomeMy WebLinkAboutF2019-0093 - Permit ApplicationCu03-20rq
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Print Form Worksheet for Fire Permit Application 04 °
City of Newport Beach - Building Division u
Please print 3 copies nb qd-I
Associated Building Permit # l 01;?_j; i Y Fire Sprinkler F_ Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Owner's Address
Tenant Name #Units �—...
2. Description of Work
Use
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Architect/Designer's Address
Architect/Designer's E-mail Address
City
Valuation $ ��
Extg Sq Ft F_, New/Added Sq Ft F Total Sq Ft F_;
inear's AddressEngineer's
[—New 7-�i
Add r Alter r Demo
# Stories F
Check Appropriate Box for Applicant/Notification
F 3. Owner's Name Last First F
Owner's Address
Owner's E-mail Address.
City
I
Stat eZip —Telephone
F 4. Architect/Designer's Name Last �— First �—, Lic. No. r
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F _ Zip F Telephoned
Engineer's Name Last IM First „ �nv� t { Lic. No.t5.
inear's AddressEngineer's
E-mail Address
Q �/�,�n
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City ONW
State Zip P�''''�i'''(!)Q't`,, Telephone `� L� I,(k-t 3
. Contractor's Name Last
NSI � II First '' Lic. No. (+��(��Q Class)
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Contractor''ss Address
Contractor's E-mail Address
City
State ( �.. .-- Zip q Telephone �I 3 Q W -
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. /
OCCUPANCY- GROUP
n (� PLAN CHECK FEE $�'
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