HomeMy WebLinkAboutF2015-0304 - Permit ApplicationVVorksheet for Fire Permit Application rsq 2015
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit #
1. Project Address (Not mailing address)
Tenant Name
14 09 D
Fire Sprinkler El Fire Alarm fl Fire Misc
r o 15 - 0 30 1-1
Floor
# Units
Suite No
2. Description of Work
Extg Sq Ft
4i3t\,c,Cce—Vcr
New/Added Sq Ft r
[7 New [7 Add El Alter . E Demo
JTotal Sq Ft n
Use LI
Valuation $
1)3_530
# Stories
Check Appropriate Box for Applicant/Notification
Information
E
3. Owner's Name Last
Owner's Address
City
State
First
Owners E mail Address
—1
Zip Telephone
El 4. Architect/Designer's Name Last
Architect/Designer's Address
Cityfl —1 State {-1 Zip
First
Lic. No.
Architect/Designer's E-mail Address
Telephone
Er 5. Engineer's Name Last
Engineers Address
City
ThNr(
1
First —(7) inarc
Engineer's E-mail Address
Lic. No.
Telephone
ri 6. Contractor's Name Last Eavjov,Lcivm
Contractor's Address
LAPC)L.&ko& LLt
State
City
First[ Lic. No. f730_, -Class] L- ( I
Contractors E-mail Address
\nt.77.1t-Ca
Zip rat.i Telephone — 6-y3,4116LE,
OFFICE USE ONLY
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
p?ot 00,-4
PERMIT NO. tatill iyek
PLAN CHECK NO 1\71-A --1290
PLAN CHECK FEE $