HomeMy WebLinkAboutF2018-0678 - Permit ApplicationWorksheet for Fire Permit Application ori
City of Newport Beach - Building Division p a
Please print 3copies �1q 400 ��olq-0679]
Associated Building Permit# -, Fire Sprinkler r Fire Alarm rFire Misc
a/ddress)
1. Project Address (Not mailing address)
Floor IrSuite No
:.
e r rG
C72,11
__ ,. f
__V ---_.----
!
7777..—
Tenant Name
r 4. Architect/Designer's Name Last
#Units
2. Description of Work
Architect/Designers E-mail Address
City State F-.
Use
-----
—'
Extg Sq Ft1777
New/Added Sq Ft -: Total Sq Ft
Valuation $
City State [777.
Zipj_ Telephoned--
# Stories W
New (` Add F-
Alter (— Demo
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last
First
Owners Address
Owner's E-mail Address
F.
-- --- --- -- -
city — 7 7 77 _ State ^.
- --- ._-
Zip Telephoned----
r 4. Architect/Designer's Name Last
First F Lic. No. F—'
Architect/Designers Address
Architect/Designers E-mail Address
City State F-.
Zip Telephoned_
r 5. Engineer's Name Last
First— Lic No. F
Engineer's Address
Engineer's E-mail Address
City State [777.
Zipj_ Telephoned--
r 6. Contractor's Name Last ,r 1 First�� Lic. No. %/r55�� Class
Contractor's Address
Contractor's E-mail Address
11.I yE1T ��—
City I C- ez rDYG J4 -__ State 7c_ ''.
Q�cl.J�
Zip l�� 3 Telephone 91i --
OFFICE USE ONLY N V
PERMIT NO.
TYPE OF CONSTRUCTION
OCCUPANCY- GROUP
PLAN CHECK
?�� PLAN CHECK FEE $