HomeMy WebLinkAboutF2018-0546 - Permit ApplicationWorksheet for Fire Permit Applicationus,
City of Newport Beach - Building Division
Pleas'a print -3 copies 1F %� r DO
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"''Associated Building Permit # ��',, '` t -Fire Sprinkler r Fire Alarm r; Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name �l # Units F�
2. Description of Work
p I Qr, Use
Valuation $!y
Extg Sq Ft F New/Added Sq Ft �� Total Sq Ft \ $D G (Lw
# Stories I `"
r/ New r–Add(", Alter [-", Demo
Check Appropriate Box for Applicant/Notification
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3. Owner's Name Last First
Owner's Address Owner's E-mail Address
City State r� Zip �--- Telephoned
r j 4. Architect/Designer's Name Last Cq avc First oscCW Lic. No.
ArchitectlDesigner's Address Architect/Designer's E-mail Address
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City -3.�� State F(R Zip C1iZS0; Telephone q51,-ZSC� S�G�
i 5. Engineer's Name Last First 3 Lic. No.
Engineer's Address Engineer's E-mail Address
City �— — — State F� Zip Telephoned
(-=6.Contractor's Name LastDt �vfAf�y� nCJKct ot1 First F_
Lic. No. 115,03Class [ /L
Contractor's Address Contractor's E-mail Address
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City fZRvev �e ®® State d Zip I c� Telephone[jZ
OFFICE USE ONLY PERMIT NO. '
TYPE OF CONSTRUCTION PLAN CHECK NO.
OCCUPANCY- GROUP PLAN CHECK FEE $