HomeMy WebLinkAboutF2018-0483 - Permit ApplicationPrint Form
Please print 3 copies
Associated Building Permit #
Worksheet for Fire Permit Application
City of Newport Beach - Building Division
M Fire Sprinkler ❑ Fire Alarm M Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Last First
Tenant Name - # Units
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2. Description of Work
Use
City
—� State F— 7
Extg Sq Ft - _ New/Added Sq Ft F7--7Total Sq Ft
Valuation $�—).�av
New n Add n Alter Demo
# Stories r
Check Appropriate Box for Applicant/Notification
[� 3. Owner's Name
Last First
Owner's Address
_
Owner's E-mail Address '� "� o�
City
—� State F— 7
Zip Telephone
[I 4. Architect/Designer's Name Last
First �— Lic. No. �I
Architect/Designer's Address
Architect/Designer's E-mail Address
City
----- —.... --.._-
State-
—I ----r,
Zip F77--7 Telephone��
5. Engineer's Name
Last --� First Lic. No.
Engineer's Address
Engineer's E- itd ss
City _
State
Zip1-7 Telephone
F-1 6. Contractor's Name Last
First Lic. No. ass
Contractor's Address
Contractor's E-mail A e
City 1
State Com_
Zip 5� Telephone
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OFFICE USE ONLY
s .
l PERMIT NO. Rn -
TYPE OF CONSTRUCTION
1
,� r PLAN CHECK NO.
�i
OCCUPANCY- GROUP
PLAN CHECK FEE $
110
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