HomeMy WebLinkAboutF2019-0454 - Permit ApplicationWorksheet for Fire Permit Application
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City of Newport Beach - Building Division F,?O17-01#54(o
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Associated Building Permit # j Fire Sprinkler r Fire Alarm r -i Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
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Tenant Name IST ,
City I NCWror&,L/`1
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2. Description of Work
Name Last I Hqn^' py, I First V`� a—, Lic. No.
Use
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Extg Sq Ft �—
New/Added Sq Ft� Total Sq Ft F:;.
Valuation$ 5,000
New F_ Add r-
Alter F7 Demo
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Check Appropriate Box for Applicant/Notification
F7 3. Owner's Name
Last V B R S r pe,4r'CS Ivy C. First
Owner's Address
Owner's E-mail Address
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Sal k-101
City I NCWror&,L/`1
-_ State �1�.__. Zip Telephone[-
F_ 4. Architect/Designer's
Name Last I Hqn^' py, I First V`� a—, Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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F7 5. Engineer's Name
Last First I Lic. No.l
Engineer's Address
Engineer's E-mail Address
City
State Zip Telephoned_
r16. Contractor's Nam
Last )+rry . u,� ! First MA� Lic. No. �3 gs51 Class Fe -1 b
Contractor's Address _
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Contractor's E-mail Address
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s State �i'T ._ Zip f2S•62-�I, Telephone[,f�T4g-zibuP
OFFICE USE ONLY
(� PERMIT NO.
TYPE OF CONSTRUCTIONr r PLAN CHECK NO. � _' 6 (_
OCCUPANCY- GROUP �GrV �/[” I
PLAN CHECK FEE $
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