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HomeMy WebLinkAboutF2018-0369 - Permit ApplicationFLO . DWI EW Pp Worksheet for Fire Permit Application o Rm Print Farm: City of Newport Beach - Building Division u r Please print 3 copies J G<,roa��" Associated Building Permit # 6CI Fire Sprinkler ❑ Fire Alarm ❑ Fire Misc 1. Project Address (Not mailing address) Floor Suite No S� G �2E Q teJ R 1 0 Tenant Name # Units F �J 2. Description of Work Owner's E-mail Address Use _ State F771 Zip [7:7:7] Telephoned 4. Arch esigner's Name g _k--;1���z Architect/Designer's Address Extg Sq Ft F___7New/Added Sq Ft � Total Sq Ft 3 Sa Valuation$ Woo New r7 Add ❑Alter r7 Demo # Stories Check Appropriate Box for Applicant/Notification ❑ 3. Owner's Name Last First Owner's Address Owner's E-mail Address City _ _ _ State F771 Zip [7:7:7] Telephoned 4. Arch esigner's Name Last �t��2) First �di� Lic. No. 36LZ Architect/Designer's Address Architect/Designer's E-mail Address ,45�7 A46aL. ® l$dL,�OLv1 City State © Zip Telephone / 9 ❑ 5. Engineer's Name Last First E77-71 Lic. No. Engineer's Address Engineer's E-mail Address City State Zip 6. Contractor's Name Last ���Telephone�� �Firstcl / i , /, , , ,, Lic. No.Til y Ji Class T �a v Contractor's Address Contractor's E-mail Address C,11. ®Q ZOLzG City ��— State Zip _ Telephone l"1Ofi7 75 ✓� ] OFFICE USE ONLY PERMIT NO. TYPE OF CONSTRUCTION i Liu PLAN CHECK NO OCCUPANCY- GROUP PLAN CHECK FEE $ r, X