HomeMy WebLinkAboutX2019-3351 - Permit Application (2)Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit #—I r Fire Sprinkler ❑ Fire Alarm r -j Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Last �— ( First F
Tenant Name �- j #Units
2. Description of Work
Owner's E-mail Address
Use
CAAW
Extg Sq Ft F New/Added Sq FtI Total Sq Ft F
Valuation $1
[i New r Add Alter r-,, Demo
# Stories
Check Appropriate Box for ApplicantlNotification
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3. Owner's Name
Last �— ( First F
Owner's Address
Owner's E-mail Address
City
StateZip F Telephone_ -
r-; 4. Architect/Designer's
Name Last First[
Lic. Nof—
Architect/Designer's Address
Architect/Designer's E-mail Address
i
city
State Zip f -- Telephone[�
_
rl 5. Engineer's Name
Last First
Lic. No.
Engineer's Address
- Engineer's E-mail Address
City -,_---_-..
._.�i State—, Zipi Telephone_—^'
F-.,'6. Contractor's Name
Last First ��- Lic. No.
Class��,
Contractor's Address
Contractor's E-mail Address
City I -,- _..,
- �State F_Zip � Telephone�J-
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $