HomeMy WebLinkAboutF2019-0621 - Permit ApplicationWorksheet for Fire Permit Application
i City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit �w1O Fire Sprinkler F_Fire Alarm [-I Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Nw�P+-_r __
Tenant Name (.6w1Gt l o rck T M_ _.-)CPVd vrn� - .{ __--- I \ # Units
"tet
2. Description of Work
Owner's E-mail Address
cki S (C
Use
Extg Sq Ft- New/Added Sq Ft F� Totai Sq Ft ----��
Valuation $ ilt sc)n
-
City vsnL,.,
�'- State�1 ZipF-Telephone(
n New [` Add �✓Alter F- I Demo
# Stories
- -
C7-)
Name Last First—
- S 2
Check Appropriate Box for Applicant/Notification
3. Owner's Name
LastTh �r v n q 1 First
_ _ --- W • i F
Owner's Address
Owner's E-mail Address
1,00
City vsnL,.,
�'- State�1 ZipF-Telephone(
4. Architect/Designer's
Name Last First—
Lic. No. l--_'
Architect/Designer's Address Architect/Designer's E-mail Address
City -.
Stater Zip (—_--_v�� Telephone���
S. Engineer's Name
Last(p t�µ Z - First 76A_o , fr/�
Lic. No. L 140
Engineer's Address
Engineer's E-mail Address
S� C.1 Z 6E
City State : Zip F Telephoned
[716. Contractor's Name
Last ��� L 1 First , . ; Lic. No. �$ y lig Class C 1b
Contractor's Address
Contractor's E-mail Address
sk
city t N ..CL4_
C,Jr -,. State F Zip �� Telephone�1/c(
'309 `O ( C40
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $