HomeMy WebLinkAboutF2019-0124 - Permit Application0NgR•2014
Worksheet for Fire Permit Application F20lR-01 ��
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # ��� Fire Sprinkler �I Fire Alarm j -I Fire Misc
1. Project Address (Not mailing address) Floor Suite No
12595 Dove S ree F
Tenant Name I Pew{'tC{e �.. Q OS t`� # Units
2. Description of Work
Use �—
�Q,�000.,�e_j
State Zip� .� elephone�
Valuation $
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Extg Sq Ft I New/Added Sq Ft F Total Sq Ft F
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Architect/Designer's E-mail Address
# Stories
F New r Add -.. Alter r Demo
State I Zip �i Telephone,
Check Appropriate Box for Applicant/Notification
Jawmataom
3. Owner's Name
Last I- First',
Owner's Address
Owner's E-mail Address
City �,.
State Zip� .� elephone�
F_ 4. Architect/Designer's Name Last First F Lic. No.
F
Architect/Designees Address
Architect/Designer's E-mail Address
City
State I Zip �i Telephone,
5. Engineer's Name
Last 7a First —' Lic. No
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Engineer's Address
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Engineer's E-mail Address
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City l rD,y� - --_.
_._ State Lam✓ ' Zip -. 926(c Telephone94q 3972d'
(Class
['6. Contractor's Name
Last FirstLic. No. 7521 qq�
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Contractor's Address
Contractor's E-mail Address
City
State Zip Telephoned.
OFFICE USE ONLY
PERMIT NO. �Z
- Q ZLJ
CA
TYPE OF CONSTRUCTION PLAN CHECK NO. t 7A
OCCUPANCY- GROUP
, (� ._ ��� L> PLAN CHECK FEE $