HomeMy WebLinkAboutF2018-0425 - Permit Application1=2DI8 - 0 Li 2,5�
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
Please print 3 copies
Associated Building Permit#XU [7 Fire Sprinkler Fire Alarm Fire Misc
1. Project Address (Not mailing address)
Floor
Suite No
1/, e L.-,
F
Tenant Name
# Units
F
2. Description of Work
� _ Telephone
Fi (a v,7 F
F_ 4. Arch itect/Desig ner's Name Lastfj1 LastFirstLic. No.F-4W_ F
011o XX UO "e -A- Ss�rle
Use F
Architect/Designer's E-mail Address
F_____
Valuation $
F_
Extg SqFt New/Added Sq Ft Total Sq Ft F_
CAA State zip Pi_Zi7_5(, TelephoneF
F7� 5. Engineer's Name
Lasti
# Stories
New F_ Add F_ Alter F_ Demo
Engineer's E-mail Address
Check Appropriate Box for Applicant/Notification
3. Owner's Name
Last
First
Owners Address
Owners E-mail Address
City
State �A Zip
� _ Telephone
Fi (a v,7 F
F_ 4. Arch itect/Desig ner's Name Lastfj1 LastFirstLic. No.F-4W_ F
Architect/Designers Address
Architect/Designer's E-mail Address
F_____
---
F_
City
CAA State zip Pi_Zi7_5(, TelephoneF
F7� 5. Engineer's Name
Lasti
FirstLic. No.
F-F
Engineers Address
Engineer's E-mail Address
city
State F_ ZipF--------7
Telephone[
6. Contractor's Name Last
%
FirstF Lic. NClass
o. 9j//c-
F;
Contractor's Address
Contractor's E-mail Address
60
6,
City aF
State zip5w-S-Z;o
Telephonf�;)Zf_91 -Mie
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. �1
OCCUPANCY -GROUP
I
PLAN CHECK FEE $