HomeMy WebLinkAboutF2019-0068 - Permit ApplicationWorksheet for Fire Permit Application o� m
0291.20lq City of Newport Beach - Building Division A
Please print 3copies F201q-0068 ILa3�?`It �'1 cvwml
Associated Building Permit # F [;?,(Fire Sprinkler [_7 Fire Alarm F-1 Fire Misc
1. Project Address (Not mailing address) Floor Suite No
a 6 via G�z �� l t� e I I [
Name -_.. __--- ---_ ---_ �F
# Units I
Tenant 1
2. Description of Work
State l Zip �— Telephoned
F_ 4. Arch itect/Designer's Name Last n , ( First Com' 117 Lic. No. (o fZF'
Use,
Architect/Designer's E-mail Address
.r I
7 F1
City &ol.
Valuation
Eztg Sq Ft F177—,c.r. New/Added Sq FtF Total Sq Ft
'
New Alter Demo
# Stories
[-1 F7*Add F_
Check Appropriate Box for Applicant/Notification
Fi 3. Owner's Name
Last I First I
Owner's Address
Owner's E-mail Address
City F_I
State l Zip �— Telephoned
F_ 4. Arch itect/Designer's Name Last n , ( First Com' 117 Lic. No. (o fZF'
Architect/Designees Address
Architect/Designer's E-mail Address
7 F1
City &ol.
State Zip '/o le, Telephone lz�
6. Engineer's Name
Last First Lic. No. —
Engineer's Address
Engineer's E-mail Address
City__
.--_ State Zip FTelephoned^--
F 6. Contractor's Name Last e/ /z First (r Lic. No. 92 z Class
Contractor's Address
Contractor's E-mail Address
e/ -r_
City ON P_..ry r �
-__ - State Zip -.. Telephone � ZG ,� �
OFFICE USE ONLY
�A� I v���l PERMIT NO. 19' U -CLO
TYPE OF CONSTRUCTION
/I 2� PLAN CHECK NO. OLE' I' 2-C 1 -_
OCCUPANCY- GROUP
PLAN CHECK FEE $