HomeMy WebLinkAboutF2019-0176 - Permit ApplicationPrint Form Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies ��\ ///
Associated Building Permit # o1 : p� Fire Sprinkler F- Fire Alarm r Fire Misc
1. Project Address (Not mailing address) `
Tenant Name
2. Description of Work
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Extg Sq Ft New/Added Sq Ft �� Total Sq Ft F_
U
Floor
Suite No
# Units
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Use I ge-3 .
Valuation $ 9 oCr9. °J
New F_ Add F_ Alter j Demo # Stories
Check Appropriate Box for Applicant/Notification
I— 3. Owner's Name Last F�
First �—
Owner's Address
f
Owner's E-mail Address
---
City [—
State [_
Zip F— TelephoneF_
F 4. Architect/Designer's Name Last
F—
___ First F_ Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City F— �—
State F_
Zip F_ Telephone F_
F 5. Engineer's Name Last F�
First F_ Lic. No. F_
Engineers Address
Engineer's E-mail Address
Cit F—�
Y
State
Zip �� TelephoneF_
6. Contractor's Name Last �,•/ First /V j� Lic No. ig Class
Contractor's Address
Contractor's E-mail Address
City V/C,jJ o
State c;
Zip i2L�STelephone 94g•l192
OFFICE USE ONLY
PERMIT NO. IV24)a^Di1Co
TYPE OF CONSTRUCTION
PLANCHECKNO.
OCCUPANCY - GROUP
PLAN CHECK FEE $
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