HomeMy WebLinkAboutF2019-0453 - Permit ApplicationWorksheet for Fire Permit Application o�`�°°"r
City of Newport Beach - Building Division 5-,;.oar.P
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Please print 3 copies •T20 Vq — V
Associated Building Permit # r— Fire Sprinkler r Fire Alarm [7 Fire Misc
1. Project Address (Not mailing address) Floor Suite No
100 kjlf l /p,&S_t/_r 7Z��j
Tenant Name Pe..__.14asrr\ J6�n jk,fa... __..i � # Units F___.'.
2. Description of Work
Use
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02,2-
Extg Sq Ft New/Added Sq FtF Total Sq Ft F_—
Valuation $ Dim,
F, New F_ Add r Alter r- Demo
#Stories \If
Check Appropriate Box for Applicant/Notification
[-I 3. Owner's Name Last V5 As Pr,,�U ,orbs 1.u. First ,
Owner's Address
Owner's E-mail Address
ioo w _Corns Nvv ���
2.-_141
City fv8wper't' ReAJA
� State'-. ... Zip, _. Telephone F
f- 4. Arch itectlDesigner's Name
Last� I First Lic. No.
Architect/Deesigner's Address
Architect/Designer's E-mail Address
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City r'11p,rr I`C ,
State C Zip [12,5U Z>. Telephone 15)
5. Engineer's Name Last
First-
- yo. F.......
Engineer's Address
Engineer's E-mail Add ess
City..
State --. Zip ,.. Telephoned'
I- 6. Contractor's Name Last
- - -
ppll A ^', First Ma Lic. No. W3 r;5 Classf <-ttr
Contractor's Address
Contractor's E-mail Address
cSonlbin }`laAtoe.L_ Ax Sw;
103
City %�i-cie t
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s. State �n Zip ZS 2... TelephoneF -3(r*'•.zo6q
OFFICE USE ONLY
TYPE OF CONSTRUCTION
\ /PERMIT NO. 9
2x\, a PLAN CHECK NO
OCCU,A'fV �dR UP
((" PLAN CHECK FEE$