HomeMy WebLinkAboutF2018-0432 - Permit ApplicationWorksheet for Fire Permit Application
Print Form City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit # R Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1..Project Address (Not mailing address) Floor Suite No
` zq_ _ VUe he — E71 0
Tenant Name # Units
2. Description of Work
for r- �-��
Use
Extg Sq Ft New/Added Sq Ft Total Sq Ft
Valuation$
# Stories
F] New F] Add ❑Alter ❑ Demo
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last 1 First
Owner's Address Owner's E-mail Address
City State Zip TelephoneF--7771
❑ 4. Architect/Designer's Name Last o First Q Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
i"dc�Q r�V o/r??G{(l C6✓lI
city S'CcOVr4q State Zip 07? Telaphone 3 0--(11
❑ 5. Engineer's Name Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City _ _ _ State Zip Telephone��
❑ 6. Contractor's Name Last �� V � S�y/ l =irst F ---- Lic. No. 9 Z(6 Class _
Contractor's Address pj Contractor's E-mail Address
7-717—
Z1 1C ✓ t �1_� /) t I/ f/i 55 {7410. L U Vli7
City CQ � �1�—e State Zip q0 Telephone �)61U-,01
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OFFICE USE ONLY t PERMIT NO.Ci��
TYPE OF CONSTRUCTION PLAN CHECK NO. `LSE " ? •� 7 V
OCCUPANCY - GROUP U PLAN CHECK FEE $