HomeMy WebLinkAboutF2019-0067 - Permit ApplicationWorksheet for Fire Permit Application o��`�
City of Newport Beach - Building Division
Please print 3 copies ef q l _ 20 k 40, p0.Y
Associated Building Permit # ZO 1 0 _3 I 1 rFire Sprinkler F: Fire Alarm r7 Fire Misc
1. Project Address (Not mailing address) ` Floor Suite No
260$2- S W. C`IpCasS �—
Tenant Name It Units
2. Description of Work
%vP.w FiYGE g�-Jr.�.�l<Ger 5 �St'erYl 3 t-le,.}Gg. Use
Valuation $ �p�i
Extg Sq Ft New/Added Sq Ft Total Sq Ft �, -
New r Add r Alter (— Demo
# Stories FF
Check Appropriate Box for Applicant/Notification
j— 3. Owner's Name Last IJ�1E io�og
First �—
Owners Address
Owners E-mail Address
City State �—'
Zip �— Telephoner—
F 4. Architect/Designer's Name Last First [_ Lic. No. �—
Architect/Designers Address
Architect/Designers E-mail Address
City F— State �—
Zip �' Telephone(------
f 5. Engineer's Name Last
First F_
Lic No. F_—
Engineer's Address
Engineer's E-mail Address
City State �—
Zip [_ Telephoned-
F 6. Contractor's Name Last Z�t����Y First sgp/Q, Lic No. 7`{to13U Class l�
Contractors Address
Contractor's E-mail Address
n
City 5;N Cjr,rnerl1C State e19
Zip &Itt L Telephone 0[c�,f�,[,)[{3,L4&6L4
OFFICE USE ONLY
PERMIT NO. �' ZD — 7
TYPE OF CONSTRUCTION _
PLAN CHECK NO. 0Z7 —Z0j'(
OCCUPANCY -GROUP IGj
_ 6S? PLAN CHECK FEE $