HomeMy WebLinkAboutX2016-4284 - Permit Application (2)Print Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
[Fire Sprinkler ❑ Fire Alarm i71 Fire Misc
�l6WnoRr
m�
5<"ows•
1. ProjectAddress (Not mailing address) Floor Suite No
—_
Tenant Name # Units
2. Description of Work
Use
Valuation
Extg Sq Ft 77 New/Added Sq Ft F7771 Total Sq Ft F
# Stories
[—J New F Add L7 Alter F Demo
Check Appropriate Box for Applicant/Notification
3. Owner's Name Last _ First
Owner's Address Owner's E-mail Address
City—� State �— Zip F777 Telephoned
4. Architect/Designer's Name Last First Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
City _ State Zip �— Telephoned
❑ 5. Engineer's Name Last — 7 First177-71 Lic. No.
Engineer's Address Engineer's E-mail Address
City State F77 Zip F:777] Telephone�_�
6. Contractor's Name Last �tii First jE',�1ti1 _ Lic. No. -7 5 Class /�
Contractor's Address Se th Ca �s f,,�f
Contractor's E-mail Address
hgoe.S, E/ CQ sa.c7 Reel`
City 5,,gtjae � State r✓%1 ZipPiZ�oryZ Telepho qCE (a %g_�tyJ/
OFFICE USE ONLY99 PERMIT NO.
TYPE OF CONSTRUCTION L UV`' PLAN CHECK NO.
OCCUPANCY - GROUP (J 2 PLAN CHECK FEE $
0,L-0,.1 , o34 V