HomeMy WebLinkAboutF2018-0464 - Permit Applicationao13-anis
Worksheet for Fire Permit Application
Print Form
City of Newport Beach - Building Division
Please print 3copies `0ulib-mol
Associated Building Permit# [Xk� ,D�R,3 lR-Fire Sprinkler [7 Fire Alarm ❑FireMisc
1. Project Address (Not mailing address) Floor Suite No
F:7
1226F77
# Units
177
Tenant Name
2. Description of(,Work
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Use
First ly�� Lic. No. �—
Architect/Designer's Address
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5zi LV ✓ E� RVQ __
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Valuation $ ao(�
Extg Sq Ft �1 New/Added Sq Ft �_� Total Sq Ft
❑ 5. Engineer's Name Last
First— Lic.No.�
# Stories
FZ7
❑ New [7 Add E] Alter ❑Demo
City _ _ _ _ State 171Zip
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last_TPUJ1h �iV1 TV -1
First
Owner's Address
Owner's E-mail Address
City State Zip
� Telephoned
❑ 4. Architect/Designer's Name Last T7777-71
First ly�� Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
5zi LV ✓ E� RVQ __
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I rV�7 (�C7V State C� Zip
17 Telephone 1/T ?O-6YC
❑ 5. Engineer's Name Last
First— Lic.No.�
Engineer's Address
Engineer's E-mail Address
City _ _ _ _ State 171Zip
17 Telephone
❑ 6. Contractor's Name Last R( UG(l/ _spy 5 . r.First �� Lic. No. � IT Class G�
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Contractor's Address
Contractor's E-mail Address
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City GVII� ! y.j State Zip
9'G Telephone F78)
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OFFICE USE ONLY
Ir -U Q • 404
PERMIT NO.
TYPE OF CONSTRUCTION
Spit
PLAN CHECK NO. pit 'qxl �
OCCUPANCY- GROUP
PLAN CHECK FEE $