HomeMy WebLinkAboutF2018-0551 - Permit Application100Worksheet for Fire Permit Application
City of Newport Beach - Building Division J
Please print 3 copies
C
Associated Building Permit # �— ( Fire Sprinkler Fire Alarm r Fire Misc
1. Project Address (Not mailing address)
Floor
Suite No
Owner's Address
#Units
F77
Tenant Name
.--------__.- —i
State F777 Zip F777 Telephoned—
2. Description of Work
Last— First— Lic. No.
�—
Use �-
Architect/Designees E-mail Address
1-7
City
Valuation $ I
Extg Scl Ft F7777 New/Added Sci FtF—� Total Scl Ft
Firsts— Lic. No.�i',
t
Engineer's Address
Engineer's E-mail Address
City
# Stories
(- New F -Add F7, Alter (- Demo
Contractor's Address
-
Check_ Appropriate Box for Applicant/Notification
-Inforluntmon
Name Last
-F-3.Owner's
�— First
Owner's Address
Owner's E-mail Address
i
City �— -.--
State F777 Zip F777 Telephoned—
I- 4. Architect/Designer's Name
Last— First— Lic. No.
�—
Architect/Designees Address
Architect/Designees E-mail Address
1-7
City
- State r Zip Telephone�—
C 5. Engineer's Name Last
Firsts— Lic. No.�i',
t
Engineer's Address
Engineer's E-mail Address
City
State �- Zip F TelephoneF77777
(-'6.Contractor's Name Last 11%,k/,`�FirstF_ Lic. No. 2�q/77� Class—'
Contractor's Address
Contractor's E-mail Address
,Iry
City 6s
State 077 Zip 94,2 •. Telephone_---.
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $