HomeMy WebLinkAboutF2019-0524 - Permit Application (3)Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies G c<opN,
Associated Building Permit Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (No Ing address) Floor Suite No
Tenant Name # Units F
2. Description of Work
/�GG� Pl,�I,---n�(?-1�5 Use ---..------
Valuation $ '
Extg Sq Ft New/Added Sq Ft F Total Sq Ft F -i
New p� ndd ❑ Alter [ Demo #Stories 2j
Check Appropriate Box for Applicant/Notification
`". Owner's Name
Last 1 First
Owner's Address
Owner's E-mail Address
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city ff - ��-J gtate {'�,� Zip
1,�L27
4. ArchitectlDesigner's
Name{ Last First rl I L l�I/ p Lic. No.N'L/
rchitect/Designer's Address
Architect/Designer's E-mail Address
City _ /1 %, � p_f���
O n i'; -;State�i Zip .. �� /'a elephone
_ - -
5. Engineer's Name
Last
__ __ First 1" Lic No.
Engineer's Address
Engineer's E-mail Address
City
State F: Zip Telephoned_—'
ontractor's Name
Last First--_' Lic. No. ClassF
_ (
Contractor's Address
Contractor's E-mail Address
n ,
Cityspa
State C !1 Zip ��C Telephone ? Ll
OFFICE USE ONLY
/ PERMIT NO.
TYPE OF CONSTRUCTION
OCCUPANCY -GROUP
1?� y� -]� PLAN CHECK NO.
(�1t/ c'-4� j
PLAN CHECK FEE $
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