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Worksheet for Fire Permit Application "` '�"r
Print Form o° m�
City of Newport Beach - Building Division
Please print 3 copies G<�.aa.,�
Associated Building Permit# �� ❑ Fire Sprinkler E] Fire Alarm ''J Fire Misc
1. Project Address (Not mailing address) Floor Suite No
— - F-7 F7
Tenant Name��__ ff �f
E%A1��� � #Units
2. Description of Work
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Use
Valuation
# Stories
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Extg Sq Ft (� � New/Added Sq Ft Total Sq Ft
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❑ New ❑ Add ❑ Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last ! j� T / First
Owner's Address Owner's E-mail Address
City _ _ _ Sta Zi — Tele hone
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❑ 4. Architect/Designer's Name Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address — J
City _ State Zip Telephone
❑ 5. Engineer's Name Last First
Lic. No,
Engineer's Address Engineer's E-mail Address
City State Zip Telephoned
F71 6. Contractor's Name Last U First , W:5 j Lic. No. c 76t I Class p l�
Contractor's Address ` Contractor's E-mail Address `� to
—_-i�
City _ _ I—t�p r I State 7 � Zip Telephon "�( i' ' L/f� b
OFFICE USEEI ONLY N F_5511 PERMITNO. 2E�W�fFF�T���7"„ ^�`y
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY- GROUP _ l I PLAN CHECK FEE $