HomeMy WebLinkAboutF2019-0605 - Permit ApplicationWorksheet for Fire Permit Application
Print Form &L -q r� f;i of Newport Beach - Building Division g
Please print 3 copies
Associated Building Permit # Fire SprinklerFire Alarm 7_ Fire Misc
1. Project Address (Not mailing address)Floor Suite No
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Tenant Name /�1/1 _1JU V �/ �U''l l i �� C I # Units
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2. Description vofrWork {, p
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Valuation $
Extg Sq Ft ' New/Added Sq Ft .Total Sq Ft
# Stories
F_, New r Add Alter r Demo
Check Appropriate Box for Applicant/Notification
Owner's Name Lastlui SI V First F
Owner's Address
Owner's E-mail Address
City
State I ...--..._ Zip /N IKV Telephonel�
4. Arch itect/Designer's Name Last —� First i -..ux Lic. No.
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Architect/Designer's Address
Architect/Designer's E-mail Address
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City T:r:W:]6
State C� Zip Ute'e Telephone
5. Engineer's Name Last`` First UIJG� Lic. No. ��}1
Engineer's Address
Engineer's E-mail Address
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State — Zip Fq u)3 Telephone I ` I 43 d� � C!�/
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Contractor's Name Last
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I I ��l �6� First Lic. No. D -3q (class G (,o
Contractor's Address
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C`Gontractor's E-mail Address
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City F" .Qj
State 1 Zip )j Telephone `1 2,VJo2�4e c�
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OFFICE USE ONLY
lei' ' , ( PERMIT NO. 1q - ou S—
TYPE OF CONSTRUCTION
1�' t7� PLAN CHECK NO. ` Ul q
OCCUPANCY- GROUPI'
y I /� PLAN CHECK FEE $
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