HomeMy WebLinkAboutF2018-0566 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire Sprinkler (7 Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
203'► I �� I%li✓ L /9i e- C:a P �c<� 4 ��I Z�0
Tenant Name # Units
2. Description of/Work
Use -
Extg Sq Ft New/Added Sq Ft F Total Sq Ft �� Valuation $.90�
--J
--
# Stories F
r, New Add Alter memo �
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name Last
II First
Owner's Address
Owner's E-mail Address
City State
F_
Zip Telephoned'
4. Arch itectlDesigner's Name Last
I First F Lic. No �i i
Architect/Designer's Address
Architect/Designer's E-mail Address
City Stated
Zip �'I Telephoned
(— 5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City State
F_
Zip �n '�. TelephoneF_
6. Contractor's Name Last First Lic. No. aSy 36' Class
Contractor's Address
Contractor's E-mail Address
r6✓' 'A '7 S
City _ Let fA-1 State
r,4- ',,
Zip / E� ,� % ',, Telephone ,f6
OFFICE USE ONLY
PERMIT NO. 1OCa • 90(,
TYPE OF CONSTRUCTION _
PLAN CHECK NO. 24-lb-1219
OCCUPANCY- GROUP
PLAN CHECK FEE $