HomeMy WebLinkAboutF2019-0077 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # t/ �+ ( ��� f;" Fire Sprinkler ' Fire Alarm (-'1 Fire Misc
QI)
1. Proj(ect%(Address (Not mailing address)
Floor
Suite No
Owner's Address
j�
Owner's E- it Address
City State
(I
Zip ��, Telephoned
Tenant Name
# Units
I First F Lic. No. F
2 Description of Work
Use
Architect/Designer's E-mail Address
f
I—,
Zip �—; Telephone`
F-, 5. Engineer's Name Last
First— Lic. No.
Engineer's Address
Extg Sq Ft New/Added Sq Ft Total Sq Ft ��'
Valuation $
$
,J l,,�.
r! New r Add r Alter r Demo 'a,�
#Stories
ff—
�I
-
First �!�o� `,� Lic. No. �� y ('�I' Class
-' -
Contractor's Address
Check Appropriate Box for Applicant/Notification
1 nFe�m n4irn
F, 3. Owner's Name Last uo Q,
First
Owner's Address
I
Owner's E- it Address
City State
(I
Zip ��, Telephoned
F_ 4. Architect/Designer's Name Last
I First F Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City �— State
I—,
Zip �—; Telephone`
F-, 5. Engineer's Name Last
First— Lic. No.
Engineer's Address
Engineer's E-mail Address
City State
F_.
Zip F—i TelephoneF_
r!6. Contractor's Name Last / r
�I
-
First �!�o� `,� Lic. No. �� y ('�I' Class
-' -
Contractor's Address
Contractor's E-mail Address
qe!°a ago
ticC6 i 't.0^.ao. Pat,
City ,��� ela�o �, State
i"
Zip �Telephone
OFFICE USE ONLY
PERMIT NO. �IpAyy���
TYPE OF CONSTRUCTION _'
PLAN CHECK NO. �P �v ,/ "�
OCCUPANCY- GROUP
�1� PLAN CHECK FEE $