HomeMy WebLinkAboutF2019-0420 - Permit Application2a iC - ijN2o
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
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1. Project Address (Not mailing address) Floor No
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Tenant Name �` j # Units I '..
2. Description of Work
City �_.
State I Zip F— Telephoned
Use —.
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Architect/Designer's E-mail Address
City I
Extg Sq Ft New/Added Sq Ft F_1 Total Sq Ft
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Valuation $
New F_ Add. r'Alter F— Demo
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Check Appropriate Box for Applicant/Notification
F 3. Owner's Name
Last -- First F
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Owner's Address
Owner's E-mail Address
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City �_.
State I Zip F— Telephoned
F 4. Architect/Designer's Name Last 1 1 QS First Lic. No. (_ '
Architect/Designees Address
Architect/Designer's E-mail Address
City I
State �— Zip I---'--� Telephoned
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F 5. Engineer's Name
Last I — First Lic. No.
Engineer's Address
Engineer's E-mail Address II
City _.. ..._.
_ State—, Zip_ Telephone_.-
rW6. Contractor's Name Last
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Contractor's Address
Contractor's E-mail Address
City ��C�tC/ovO�
Statef_ 1 Zip Telephone aq
OFFICE USE ONLYfi
TYPE OF CONSTRUCTION1�/J
,g7� PERMIT NO.
PLAN CHECK NO.
OCCUPANCY - GROUP
k 7 �)�� 7z' PLAN CHECK FEE $
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