HomeMy WebLinkAboutF2019-0025 - Permit ApplicationWorksheet for Fire Permit Application 0125 -20j4 oaPo
City of Newport Beach - Building Division F'2019 -0025 o
Please print 3 copies �•.a.�"
Associated Building Permit # Fire Sprinkler (-I; Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor j Suite No
_
I I
Tenant Name-- - # Units r
2. Description of Work
_
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Use I_
Extg Sq Ft—. New/Added Sq Ft-. Total Sq Ft �'
Valuation $ t}..
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New F_ Add t.-- Alter F— Demo
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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 F_
Zip F— Telephoned
F_ 4. Arch itect/Designer's Name
Last
First F Lic. No.
Architect/Designers Address
Architect/Designers E-mail Address
City i -...
State
Zip Telephone
5. Engineer's Name Last
Itr l �ls r
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i-
First I —Lic. No. I v
...-__._ ..._..__. -----------.
Engineer's Address
Engineer's E-mail Address
City
State �—
Zip ( Telephoned
F 6. Contractor's Name Last �y First �M [ y Lic. No, 76004 Class 16
Contractor's Address
Contractors E-mail Address
1161
City! L•-��#�lt
State Clk _...
Zip i;l. Telephone 71k.4.71
OFFICE USE ONLY
2
2C `-4 PERMIT NO.
OF
UDE5s r' Pj
TYPE CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $