HomeMy WebLinkAboutX2019-0035 - Permit ApplicationP P Worksheet for Fire Permit Application
Print Form
City of Newport Beach - Building Division
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Associated Building Permit #
r- Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name l)V--vr C `v tJ # Units
2. Description of Work
City _
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_... State F--- Zip— Telephone F_
Use
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City
Extg Sq Ft r- New/Added Sq Ft F—Total Sq Ft F_
Valuation $ A� & b -
F_ New F - Add F_ Alter r Demo
# Stories I
Check Appropriate Box for Applicant/Notification
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F_ 3. Owner's Name
Last First r- - - -
Owner's Address
Owner's E-mail Address
City _
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_... State F--- Zip— Telephone F_
F_ 4. Architect/Designer's Name Last-- -- First --' Lic. No. - --
Architect/Designer's Address
Architect/Designer's E-mail Address
City
_ State F_Zip I--- Telephoner-
1- 5. Engineer's Name
Last First Lic.No. F
Engineer's Address
Engineer's E-mail Address
City
State F- Zip F Telephoner_
�6.Contractor's Name Last C�^fy(NS- First �-'y Lic. No. KviI�3Classr —
Contractor's Address
Contractor's E-mail Address
City
State r � - Zip `A o D 6 Telephone (i Y 6� �i
OFFICE USE,ONLY`
PERMIT NO. r , — C)7 l
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
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