HomeMy WebLinkAboutF2019-0282 - Permit ApplicationPrint Form
Please print 3 copies
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Associated Building Permit #
PC Fire Sprinkler r Fire Alarm r Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name # Units
2. Description of Work
UseF
F re CTn'A (.g `tar 30 Sprr',i klolS)
Extg Sq Ft F New/Added Sq Ft I— Total Sq Ft �—
Valuation$ SQO
�
I- New F_. Add I- Alter r Demo
# Stories
Check Appropriate Box for Applicant/Notification
Information
F_ 3. Owner's Name
Last 1tc- First
Owner's Address
Owner's E-mail Address
nq
%yAtJ6,ii.- car I
City F—
�b State Zip � TelephoneF—
ci 4. Architect/Designer's Name
Last First JA N Lic. No.l -
ArcghitecUDejsigner's Address
Architect/Designer's E-mail Address
SC IV 56 `f Q P
Ave TWOULtr SS® nypai . C-to
frII
City 054 GVrf49
tt
State C/q zip I p71ce Telephone i719)3
F_ 5. Engineer's Name
Last First F Lic. No. f - ----
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip F Telephone
r-6. Contractor's Name Last .,re5V,ap-j l � �r First l Lic. No. 9[ ZoaZ Class
Contractor's Address
Contractor's E-mail Address
a5Y3 V,c�erra Ave _ r ye �arI - 9r 1... �w1
City SOUf� Gq�Q
q
State Fb�— Zip Telephone ?ly)�
OFFICE USE ONLY
�W1�.( (3 PERMIT NO. -Oyr?
TYPE OF CONSTRUCTION
ty L � PLAN CHECK NO. MO ANI
OCCUPANCY - GROUP
�16 PLAN CHECK FEE $