HomeMy WebLinkAboutF2019-0391 - Permit ApplicationWorksheet for Fire Permit Application o�E�Po
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # Fire SprinIder Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
Tenant Name
2. Description of Work
JNS/�/��Oa. BI` .Q- IUOGa.J ryjG c/J.2/iV�c/C�.,e.
Extg Sq Ft �— New/Added Sq Ft
% New r Add r Alter F- Demo
L;necK Appropriate box for ApplicantlNotification
- fill Floor Suite No
AX8(0
Total Sq Ft
Use
Valuation $
7,
#Stories
F- 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City -
State �
Zip Telephoned
W=LAmhitec esigner's Name
Last First Lic. No.
ArchitecVDesi ers Addres
Architect/Designer's E-mail Address
City _
State
Zip F— Telephone!
F 5. Engineer's Name Last
First; �—
Lic. Na.
Engineer's Address
Engineer's E-mail Address
City
State �—
Zip �— Telephone[-
t.'
6. Contractors Name Lasti
,,
First �(j�— Lic. No. 9j $/JS Classy
Contractors Address
Contractor's E-mail Address
!/¢ LAS �/oA-r-s
' '
i l�: l kaL (iiG.�rek�-r'cvt � y rv+�.i l • �+wt
City i ALASo (/ J6
State i A
Zip F92&5(,7 � Telephon 9¢9) V98- /I ge
OFFICE USE ONLY
_
PERMIT NO. g7 ccl ' p S'N t
TYPE OF CONSTRUCTION
PLAN CHECK NO. ())
OCCUPANCY - GROUP
/i
Z PLAN CHECK FEE $