HomeMy WebLinkAboutF2019-0194 - Permit ApplicationPrint Form F1_01q -CAC111-orksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit#
Fire Sprinkler FireAlarm
O R(�
Fire Misc
1. Project Address (Not mailing address) Floor Suite No
121 Sll r<, I Drl ve _ F-
Tenant Name # Units
2. Description of Work
City
� 32 h���lsJ
Use
Extg Sq Ft New/Added Sq Ft I Total Sq Ft
Valuation $ S Opd
Architect/Designer's E-mail Address
# Stories L
F_ New F_ Add Alter F_ Demo
City e5i COVI,Iq
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name Last l
First F
Owner's Address
Owner's E-mail Address
City
State Zip Telephone
F_ 4. Architect/Designer's Name
Last 10 Q First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
rL> uUdsS/
City e5i COVI,Iq
1co
State C' Zip, 6ff77 ef Telephone
/
5. Engineer's Name Last
First F Lic. No. r- --
Engineer's Address
Engineer's E-mail Address
City
State r Zip �', Telephone
6. Contractor's Name Last Ft�2�vdr { SpYf�C(j('r First Lic. No. Fqq%02 Class /I......�........�
Contractor's Address
Contractor's E-mail Address
15Y3 V,`cawt`g
� lsc Uarc ss6ypgf1. cn,-�,
City K, L (-,4 ,
State 61 Zip Telephone (1 «) 3to, Pl l C
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $