HomeMy WebLinkAboutF2020-0399 - Permit ApplicationWorksheet for Fire Permit Application ®roPlease print 3 copies City of Newport Beach - Building Division
Associated Building Permit#�cl4 re Sprinkler (—; Fire Alarm r Fire Misc
t. Project Address (Not mailing address)
Floor Suite No
Owner's Address
Owner's E-mail Address
I ,
Tenant Name a
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# Units
2. Description of Work
Architect/Designer's E-mail Address
Use00
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F-' S. Engineer's Name Last f
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A-, Z_
Extg Sq Ft
F—!
New/Added Sq Ft I I Total Sq Ft i
Valuation $ O
— -
r-1 New F_ Add
Iter F Demo
# Stories
r
— A —s
Check Appropriate Box for Applicant/Notification
ri 3. Owner's Name Last—
First,
Owner's Address
Owner's E-mail Address
City _.. _. _ State
I Zip r---. Telephoner-,�
4. Architect/Designer's Name Last
1 First Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City �— StateF--
Zip Telephone
F-' S. Engineer's Name Last f
First —' Lic No.
Engineer's Address
Engineers E-mail Address
city State
F_ Zip Telephone F_
Contractor's Name Last A%X % Firstr -- Lic. No. F3Z3 Class
Contractor's Address
Contractor's E-mail Address
r
City State
G//i- Zip I �yl. �.o . Telephone,
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. Or ��— Z4V
OCCUPANCY - GROUP
t2 J PLAN CHECK FEE $