HomeMy WebLinkAboutF2019-0095 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies rzo t Gt . 0 U a
Associated Building Permit # �— n Fiiire Sprinkler rl Fire Alarm j - Fire Misc
EQ)
1. Project Address (Not mailing address)
Floor No
t120
Owner's E-mail Address
(Suite
Tenant Name
City F
# Units I
2. Description of Work
FirstJP y Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
5,16 N S adY a -Ave
Use
(U j
Fre cT) ltd klfR r '-)r dvp12i�_ \ l� �e�Qs)
l
EMg Sq Ft F—
New/Added Sq Ft I 'Total Sq Ft
Valuation$ F1,
000 --
New F- Add#
r Alter F` Demo
Stories I �
Check Appropriate Box for Applicant/Notification
F7'. 3. Owner's Name LastFirst,
Owner's Address
Owner's E-mail Address
I
City F
State yam. Telephone[ _.
4. Arch itecUDesigner's Name Last
FirstJP y Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
5,16 N S adY a -Ave
_ 'r�e> �ccf� �Sr�c 9/yrQ,'l. c��r"
City WQsT /0✓(vla
r ,,
StateI Zip G(/7[Zf Telephoner7 7(�N
1`7 5. Engineer's Name Last
First-- Lic. No. F --,
Engineer's Address
Engineer's E-mail Address
City _
State �— Zip F—,--; Telephone[
rI6. Contractor's Name Last I F Y' �C?r SP//�jk� girstr_ —', Lic. No. r��G� Z class U
Contractor's Address
Contractor's E-mail Address
City vt tci(7-2
l,!'7... /�V O Telephone /
State ZiP 1 2 � (,ZN)7/0-o fl /
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $
�)V1-$01 I'm Ub xuls 1 *