HomeMy WebLinkAboutF2018-0442 - Permit ApplicationF�_DIF - D L4 L4 2 -
Worksheet for Fire Permit Application
Print Form771
Division
City of Newport Beach - Building
Please print 3 copies
Associated Building Permit # ❑ Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1.. Project A—d7dress (Not mailing address) Floor Suite No
1771
Owner's Address
Tenant Name `� _ _ o # Units F
2. Description of Work
State C� Zip F— Telephone
❑ 4. Architect/Designer's Name Last
Use
Architect/Designer's Address
Architect/Designer's E-mail Address
City
Extg Scl Ft New/Added Scl Ft Total Scl
Valuation $ s�C`fJ
ew ❑ Add ❑ Alter ❑ Demo
# Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City
State C� Zip F— Telephone
❑ 4. Architect/Designer's Name Last
First F-- Lic No. [
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F— Zip F Telephone L_71
5. Engineer's Name Last L\�F��c —� First Lic. No.
Engineer's Address
Engineer's E-mail Address
City `���r�
State Zip Telephone
— J
❑ 6. Contractor's Name Last
Fiirrst—}
7 Lic. No. � ClassF_7
Contractor's Address
Contractor's E-mail Address
City --�
State C7 Zip L-71 TelephoneF 7
OFFICE USE ONLY
PERMIT NO. FU l9, • 744,z
TYPE OF CONSTRUCTION
PLAN CHECK NO. i (5 ° �6 t 3
OCCUPANCY- GROUP
--V,„ q C1 PLAN CHECK FEE $
X79 n e int_