HomeMy WebLinkAboutF2019-0506 - Permit Application-3,t «9- 6VIJ�
Worksheet for Fire Permit Application®rzPrint Form City of Newport Beach - Building Division Please print 3 copies
Associated Building Permit # F_ Fire Sprinkler Fire Alarm r Fire Misc
1. Project Address (Not mailing address) PAP I Floor Suite No
PIT
FTenant Name #Units
2. Description of Work
Use
Valuation $ �3 Z
Extg Sq Ft � New/Added Sq Ft F__ Total Sq Ft
# Stories I
F_ New F_ Add F-AlterF-Demo
Check Appropriate Box for Applicant/Notification
F_ 3. Owner's Name Last
�� l ft lI✓li ,01 PA J First F
Owner's Address
Owner's E-mail Address
1 ))V, 1 tl IV
I
City Z A � x b.
State I '" / k- Zip C 'bC 1.7 Telephone
r 4. Architect/Designer's Name
Last First F_ Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �— Zip Telephoned
r 5. Engineer's Name Last
`V First 1Gj{ Lic No. F1 6`F /�
1•
Engineer's Address
l
Engineer's E-mail Address
vz, I & 14,VJ>
wi
City �1 ��W �ph'A
State C •i Zip `/ / 7 ( Telephone �7 G GI" jCs - I "tv
r 6. Contractor's Name Last
ZI � p�/�'/W r{!�(5Ya First F_Lic No. � Class
I
Contractor's Address
Contractor's E-mail Address
City
State Zip [_ Telephoned
OFFICE USE ONLY
PERMIT NO.
6
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY - GROUP
PLAN CHECK FEE $