HomeMy WebLinkAboutF2018-0359 - Permit Application�7_
Worksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies �o„r>
Associated Building Permit # Fire Sprinkler r7 Fire Alarm L7 Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name ,� i #Units
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2. Description of Work
Owner's Address
Use
City
State
Extg Sq Ft New/Added Sq Ft Total Sq Ft
Valuation$��
J>_�<ew ❑ Add ❑ Alter ❑ Demo
# Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last
Firs
ild
Owner's Address
Owne ress
City
State
Zip I Telephone
❑14. Architect/Designer's Name Last
First
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City _
State
Zip Telephoned
❑ 5. Engineer's Name Last
�,
First �.r�r
Lic. No.
Engineer's Address
Engineer's E-mail Address
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u
City �� h�
State, ®
Zip Fy ,., .> \ Telephone �t� �,.�
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❑ 6. Contractor's Name Last
First Lic. No. �J ClassF
Contractor's Address
Contractor's E-mail Address
City
Slate 1
Zip A Telephone
OFFICE USE ONLY
PERMIT NO.
4V 7
TYPE OF CONSTRUCTION
OCCUPANCY - GROUP
PLAN CHECK NO. UkAofiggg
PLAN CHECK FEE
$
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1. 14