HomeMy WebLinkAboutF2017-0196 - Permit Application,M I- U i ul w Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit# !� Fire Sprinkler r Fire Alarm r Fire Misc
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1.Project Address (Not mailing address) Floor Suite
LA J Vo,\ First
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#Units
Tenant Name
_
2. Description of Work
Use r__
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Last �— First l Lic. No. F
NFPA �3 D s s�cw,,,
Architect/Designees E-mail Address
City _..... __. _.
Valuation $ 3F dJ� , -'
Extg Sq Ft � � New/Added Sq Total S Ft �—i q Ft
I First Lic No.
F_1 New (` Add r Alter Dema13
0_1�K�i
#Stories
Check Appropriate Box for Applicant/Notification
Infn�m �4inn
F– 3. Owner's Name Last
LA J Vo,\ First
Owner's Address
/ Owner's E-mail Address
i
City
StateZip F Telephoned
4. ArchitecUDesigner's Name
Last �— First l Lic. No. F
Architect/Designer's Address
Architect/Designees E-mail Address
City _..... __. _.
State F_,.... Zip F— Telephoner
[7 5. Engineer's Name Last
I First Lic No.
Engineer's Address
Engineer's E-mail Address
City
State Zip—; Telephone
First M -)&,-y Lic. No. 8ClassR.
r16. Contractor's Naar¢: Last L1r, cy_.
,.. _ _
Contractor's Address
Contractor's E-mail Address
City L�.'Cla1e.• _... _
State Com. ZipI ) V b'� ,, Telephone �°� 6__- 376
T
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
QQ
PLAN CHECK NO. 09
OCCUPANCY - GROUP
`� �3�� PLAN CHECK FEE$