HomeMy WebLinkAboutF2019-0472 - Permit ApplicationJ94)-;414 FZOIR-047,9
Worksheet for Fire Permit Application
Print Form; City of Newport Beach - Building Division a
Please print 3 copies
Associated Building Permit# ❑Fire Sprinkler F] Fire Alarm ❑FireMisc
1. Project Address (Not mailing address)
Floor Suite No
Owner's Address
Owner's E-mail Address
Tenant Name`; / in, � 9
, ;
#Units
2. Description of Work
City
State E77ZipF Telephoned
❑ 4. Architect/Designer's Name Last First
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
Use
State Zip Telephoned
Valuation$�I
Extg Sq FtNew/Added Sq Ft� Total Sq Ft
Lic. No.
❑ New ❑ Add
❑ Alter [ Demo
# Stories
Check Appropriate Box for Applicant/Notification
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❑ 3. Owner's Name
Last �— First
Owner's Address
Owner's E-mail Address
City
State E77ZipF Telephoned
❑ 4. Architect/Designer's Name Last First
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip Telephoned
❑ 5. Engineer's Name
Last First
Lic. No.
Engineer's Address
Engineer's E-mail Address
City State � Zip TelephoneF
❑ 6. Contractor's Name Last ; , IF; First r � Bio �i.��, �. Lic. No. Class
Contractor's Address
Contractor's E-mail Address
7 l
71, wv
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City , -
State r Zip Telephone
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OFFICE USE ONLY
.2-0 vp 1:1 C7 PERMIT NO.
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TYPEOFCONSTRUCTION
nw1g,04aICi PLAN CHECK NO. ObSLID 0
OCCUPANCY - GROUP
i prcI'D PLAN CHECK FEE $