HomeMy WebLinkAboutX2019-3967 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # �j (!; Fire Sprinkler F-j Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name % it. ' eJ" # Units
2. Description of Work
Extg Sq Ft �� New/Added Sq Ft - Total Sq Ft
rt 1 OLW t CA5
New [-� Add [—; Alter [ I Demo �l
Use �^ C_
Valuation $ [�)oc)<D
# Stories " T
Check Appropriate Box for Applicant/Notification
information
3. Owner's Name
Last
First
Owner's Address
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Owner's E-mail Address
I
City
State Zip
-
Telephone
rl 4. Architect/Designer's Name Last
i First 1 Lic. No.F_7
Architect/Designer's Address
Arch itect/Designer's E-mail Address
City _
State Fj Zip Telephone 7
F7I 5. Engineer's Name
Last First Lic. No.77�
Engineer's Address
Engineer's E-mail Address
City C—
State Zip
Telephone
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6. Contractor's Name Last
C
First Lic. No. ")`� o.J'�q Class
Contractor's Address
Contractor's E-mail Address
117
City State C _ Zip
iik-4- Telephone
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
' j
OCCUPANCY- GROUP
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PLAN CHECK FEE $