HomeMy WebLinkAboutF2019-0276 - Permit ApplicationWorksheet for Fire Permit Application io-MY4Q•Uzof �`'`W�°°m
City of Newport Beach - Building Division 1
Please print 3 copies J /),Z 1 V, I A-4
Associated Building Permit # jJ Fire Sprinkler r Fire Alarms �, Fire Misc
1. Project Address (Not mailing address) ���� , W1(r�3&lbor Suite No
Tenant Name #Units r__
2. Description of Work
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City
State I� Zip Telephoned:
F_ 4. Archit cUDesigner's Na
Extg Sq Ft �— New/Added Sq Ft —i Total Sq Ft --
Valuation $
Add Alter Demo
# Stories
7/'New r r- F-
F71, 5. Engineer's Name Last
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name Last
First F
Owner's Address
Owner's E-mail Address
i
City
State I� Zip Telephoned:
F_ 4. Archit cUDesigner's Na
Last �4 � First Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City �
.. State Zip F ii Telephone)
F71, 5. Engineer's Name Last
First— Lic. No. F --,
Engineer's Address
Engineer's E-mail Address
City ---.._-._._ ..---------
- State F-------. Zip F Telephone (_ -----.i
(-16. Contractor's Name Last F(9re5 First ,(,(rLic. No. Pg Class LO
Contractor's Address
Contractor's E-mail Address
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City [_R.1L/4.
State F0, 4r Zip K. Telepho
OFFICE USE ONLY
PERMIT NO. / 4 QZ%
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY -GROUP
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PLAN CHECK FEE $