HomeMy WebLinkAboutF2018-0605 - Permit ApplicationWorksheet for Fire Permit Application o4�EW�Re
Print Form City of Newport Beach - Building Division
Please print 3 copies .,"op,,.>
Associated Building Permit # �— ire Sprinkler ❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address)
Floor Suite No
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F7 7
Tenant Name- ALsci!1 -
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# Units
1-71
2. Description of Work
Zip F7777 Telephone —
❑ 4. Architect/Designer's Name Last
L—__7
First =_— Lic. No.l
II__
Use
__JJ
Architect/Designer's E-mail Address
_.- —
City �— _ -
—
State I
- --7-7
Zip � TelephoneC—
❑ 5. Engineer's Name Last
Extg Sq Ft ��
New/Added Sq Ft Total Sq Ft
Valuation$
New r7 Add
❑Alter ❑Demo
# Stories
Check Appropriate Box for Applicant/Notification
n 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
City
State 1
Zip F7777 Telephone —
❑ 4. Architect/Designer's Name Last
L—__7
First =_— Lic. No.l
II__
Architect/Designer's Address
__JJ
Architect/Designer's E-mail Address
_.- —
City �— _ -
—
State I
- --7-7
Zip � TelephoneC—
❑ 5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State F77
Zip F-7-71 Telephone
r-6. Contractor's Name LastV_-First Lic. No. Class C�
Contractor's Address
Contractor's E-mail ress
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City
State t�
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P `l0-a?�� Telephone
OFFICE USE ONLY ` iJ` 7/(� `�
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN -CHECK NO.
OCCUPANCY - GROUP
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I �' PLAN rHECK FEE $
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