HomeMy WebLinkAboutF2019-0261 - Permit ApplicationF 7,0 \c) — OZO I
Worksheet for Fire Permit Application o�`W �R p
Print Form ;; City of Newport Beach - Building Division
Please print 3 copies �.�;,op,,.P
Associated Building Permit # I Fire Sprinkler ❑ Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name LSF 2 C, lj i k # Units
2. Description of Work
City I
State F_77 Zip F777 Telephone F_
T„SF4(� is Wtls
Lic. No.
Use
Architect/Designer's E-mail Address
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City
Valuation $ ?�� U u U
71
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City
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
First F77-71
Owner's Address
Owner's E-mail Address
City I
State F_77 Zip F777 Telephone F_
4. Architect/Designer's Name Last
Lic. No.
ArchitecttDesigner's Address
Architect/Designer's E-mail Address
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City
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State Zip C Telephone
[1 5. Engineer's Name Last C—�
First F777_71 Lic. No. �—
Engineer's Address
Engineer's E-mail Address
City
State � Zip C— Telephone�—
F)6.Contractor's Name Last i�u/`r A_ First Lic. No. Sc� I Class IOrir
Contractor's Address
Contractor's E-mail Address
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City ;�/��_� �
State a, Zip q3,�U` Telephone[7
OFFICE USE ONLY PERMIT NO.
TYPE OF CONSTRUCTION�J”
OCCUPANCY- GROUP
/ ° fl� PLAN CHECK NO.
PLAN CHECK FEE $