HomeMy WebLinkAboutF2018-0329 - Permit ApplicationFI'D v70 -oma
"Print Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application ��` ,
City of Newport Beach - Building Division
Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. (Not mailing address) Floor Suite No
uPro�JLVj/ect yA�d�dress
z (U '1 o (�C g it 'd' t F 1
Tenant Name # Units E71
2. Description of Work
City _
State 7 Zip F 7
Telephone _777-71
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I/� First I 1 1 , Lic. No. [�
Use
Architect/Designer's E-mail Address
52�
Valuation$ 5000
Extg Sq Ft F-71 New/Added Sq Ft Total Sq Ft
State Zip I' �� Telephone
# Stories
❑ New ❑Add ❑Alter [7 Demo
Engineer's E-mail Address
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City _
State 7 Zip F 7
Telephone _777-71
❑ 4. Architect/Designees Name Last
I/� First I 1 1 , Lic. No. [�
Architect/Designer's Address
Architect/Designer's E-mail Address
52�
s
(1_ R - Mo
CitylV°�:1
State Zip I' �� Telephone
❑ 5. Engineer's Name Last First Lic. No.t_t
Engineer's Address
Engineer's E-mail Address
City
State Zip Telephoned
[76. Contractor's Name Last I Y�eRVL1�� �- First Lic. No. 270jZ Class
Contractor's Address"
Contractor's E-mail Address
R5�3 Vidsfra Ave
, � r" SS (wnlat l • Cartel
city a__ '�Ae
State Zip ®Z Telephone�r f
OFFICE USE ONLY
PERMIT NO. �� `O X72"1
TYPE OF CONSTRUCTION
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// PLAN CHECK NO.
Y
OCCUPANCY- GROUP
PLAN CHECK FEE $
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