HomeMy WebLinkAboutF2019-0288 - Permit ApplicationWorksheet for Fire Permit Application
Print Form
`� City of Newport Beach -Building Division
Please print 3 copies —C)2_4:6�
Associated Building Permit #
f— Fire Sprinkler F Fire Alarm F— Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name. �}/�'L.6I #Units
2. Description of Work
Use
City
State �� Zip Telephoner
(_ 4. Arch itect/Designer's Name Last
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Valuation $ dOv
Extg Sq Ft �� New/Added Sq Ft I Total Sq Ft F_
Architect/Designees E-mail Address
New Add Alter r
X Demo
# Stories a
\v
_
F_ 5. Engineer's Name Last
First Lic. No. F
Check Appropriate Box for Applicant/Notification
r 3. Owner's Name Last First'' e
Owner's Address
Owner's E-mail Address
City
State �� Zip Telephoner
(_ 4. Arch itect/Designer's Name Last
First F Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City ',
State F_ Zip Telephone
F_ 5. Engineer's Name Last
First Lic. No. F
Engineer's Address
Engineer's E-mail Address
City �,
State zip �� Telephone
F 6. Contractor's Name Last ee JC ty Fir , �G Lic. NoC. � Class /G czo
Contractor's Address
6/ Contractor's E-mail Address
City �."Sy „�'
J
Statez�__
OFFICE USE ONLY
�ZDI ` ®C7 Z 1 PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
1 Z d ( PLAN CHECK FEE $
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