HomeMy WebLinkAboutM2005-0050WORKSHEET FOR BUILDING FIRE PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DEPARTMENT
�R TYPE
PLI
ROJECT ADDRESS (NOT MAILING ADDRESS)
P FLOOR SUITE NO.
...... .........
No. UNITS
f LOT BLOCK TRACT
72. DESCRIPTION OF WORK Y ?-Q 1
Z�� 4-t/ S V-� 4, tv
N EW F� ADD ALTER F-1
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Check Appropriate Box
F� 3. OWNER'S NAME LASk4
OWNER'S ADDRESS
!3
'ITY
I STATE
F-1 4. ARCH ITECTIDES IG N ER'S NAME LAST
DEMO
OWNER'S E-MAIL
# OF STORIES
VALUATION$
SQ FT
(NEW/ADDED/E)CTG)
/�-r�; -e-
ZIP PHONE NO.
FIRST TuC. NO.
ARCH ITECT/DESIGN ER'S E-MAIL ADDRESS
ZIP PHONE NO.
FIRST STATE LIC. NO.
ENGINEER'S E-MAIL ADDRESS
ZIP
PHONE NO.
BUS�NESS LIC.
ARCH ITECT/DES IG NER'S ADDRESS
CITY
STATE
;'05-4,lass
U, 5. ENGINEER'S NAME
LAST
'S ADDRESS
PERMIT NO.
STATE
TOR'S N AME A,
J-7
CITORSADDRES 4�C
PLAN CHECK ENG.
STAe�E
P
DEMO
OWNER'S E-MAIL
# OF STORIES
VALUATION$
SQ FT
(NEW/ADDED/E)CTG)
/�-r�; -e-
ZIP PHONE NO.
FIRST TuC. NO.
ARCH ITECT/DESIGN ER'S E-MAIL ADDRESS
ZIP PHONE NO.
FIRST STATE LIC. NO.
ENGINEER'S E-MAIL ADDRESS
ZIP
PHONE NO.
BUS�NESS LIC.
STATE LIC.
(5�0/M73�'No-
;'05-4,lass
CONTRACTOR'S E-MAIL ADDRESS
PERMIT NO.
71A
PLAN CHECK NO.
PLAN CHECK FEE $
PLAN CHECK ENG.