HomeMy WebLinkAboutF2020-0283 - Permit ApplicationWorksheet for Fire Permit Application
City of Newport Beach - Building Division _ o
Please print 3 copies
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Associated Building Permit # F Fire Sprinkler (-, Fire Alarm j -I Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name # Units �-
2. Description of Work
City
iState ZiP r— Telephone
Use
Last I�Qr �,� �O��irstF— Li .N Lam( ZFj
11
Extg Sq Ft �— New/Added Sq Ft Total Sq Ft (� jr
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Valuation $
- -
r New F` Add r Alter F_ Demo
# Stories
Check Appropriate box for Applicant/Notification
(-i 3. Owner's NameLast
. W i��_ Q L 1
W I _...i First
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Owner's Address
Owner's E-mail Address
City
iState ZiP r— Telephone
F_ 4. Architect/Design r'sName
Last I�Qr �,� �O��irstF— Li .N Lam( ZFj
11
Architect/Designer's Addr s
Architect/Designer's E-mail Address
171Ct
City �nn�]-
-_-- - State C.�i' ZiP_ 6-- -.. Telephone���,ip4
F-; 5. Engineer's Name
Last
9 rC� Q� rbc' a Lic. No. IA-Md�
En//gineer's Address
Engineers EE -mail Address
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City �n�2'�Q�y-- _ State zip (�''��-°' Telephonefir rr
F76. Contractor's Name
Last �j� 7_—�® � �j r®�_® ��-fg7b
�� { �� First Lic No. d assrr
Contractor's Address
Contractor's E-mail Address
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City ��'
State FC q, '_ Zip O I �,. Telephoned T ,��t C%
OFFICE USE ONLY
v PERMIT NO. •
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TYPE OF CONSTRUCTION
PLAN CHECK NO. •
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OCCUPANCY - GROUP
PLAN CHECK FEE $
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