HomeMy WebLinkAboutF2019-0059 - Permit ApplicationWorksheet for Fire Permit Application City of Newport Beach - Building Division FSO jq oO5 q(9) Please print 3 copies
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Associated Building Permit# , ire Sprinkler [-I Fire Alarm (--! Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name V # Units
2. Description of Work
Use--
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Owner's E-mail Address
Extg Sci Ft —i New/Added Sci Ft —� Total Sq Ft —!
Valuation $
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# Stories j
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Check Appropriate Box for Applicant/Notification
F73. Owner's Name Last
First',
Owner's Address
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Owner's E-mail Address
City -..
State
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Zip Telephone
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4. Arch itectlDesigner's Name
Last F—
First F Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City �—
State
F
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Zip— Telephone
r 5. Engineer's Name Last
First F_ Lic. No.
Engineer's Address
Engineer's E-mail Address
City �— -.-. -
_ State
Zip F-� Telephone_—_,
F-6. Contractor's Name Last �— First Lic No, lassF0
Contractor's Address
Contractor's E-mail A res
City
�,, State
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Zip _��� Telephone's\yid-l��D
OFFICE USE ONLY
PERMIT NO. �Za eI •�t75
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $