HomeMy WebLinkAboutF2018-0591 - Permit ApplicationWorksheet for Fire Permit Application "EWER
Print Form City of Newport Beach - Building Division o
Please print 3 copies �1l��OPp.1
Associated Building Permit # Fire Sprinkler ❑ Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name # Units F7
2. Description of Work
City _ -- -
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4. Architect/Designer's Name Last
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Arch7itte'cUDesignerr'sAddress
Architect/Designer's E-mail Address
Valuation $ �Qi Qp
Extg Sq Ft New/Added Sci Ft Total Sq Ft ��
n New F Add F Alter r7Demo
# Stories
Check Appropriate Box for Applicant/Notification
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3. Owner's Name Last (� irst
Owner's Address
Owner's E-mail Address
City _ -- -
State �] Zip[ Telephoned
4. Architect/Designer's Name Last
Ua First U Lic. No. ��
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Arch7itte'cUDesignerr'sAddress
Architect/Designer's E-mail Address
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City �Vprjt_._..S.UVtI�°( —
State C4 Zip Telephone �.
❑ 5. Engineer's Name Last L__—
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City
Telephone
State [(/ Zip �� �77
n 6. Contractor's Name Last It—(1YQ o1
dRY DI r ✓) �(C First F Lic. No. �'�Z06 Class 1 G
Contractor's Address
Co tractor's E-mail Address
City _ —�R _
State Zip(7270 Teleph ne 7//�-
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OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO.
OCCUPANCY- GROUP
PLAN CHECK FEE $