HomeMy WebLinkAboutF2018-0584 - Permit ApplicationF2_019- Ot�gq
Worksheet for Fire Permit Application z SEW-,
Form 3
Print'City of Newport Beach - Building Division 3
Please print 3 copies
Associated Building Permit# XFireSprinkler❑ Fire Alarm ❑ Fire Misc
1. Project Address (Not mailing address) Floor Suite No
Tenant Name ` �(� # Units ❑
2. Description of Work
Owner's E-mailmail A���
_�.f _-___
-- __- ---- ---_ ------
City _
Use
[7 4. Architect/Designer's Name Last
--------------
- _ First— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
I
Extg Sq Ft New/Added Sq Ft tJ Total Sq Ft t
New n Add ❑ Alter ❑i Demo
Valuation $ a�lac�
-- -
# Stories
Check Appropriate Box for Applicant/Notification
❑ 3. Owner's Name Last
Firs
Owner's Address
Owner's E-mailmail A���
_�.f _-___
-- __- ---- ---_ ------
City _
State F J Zip J Telephone I
[7 4. Architect/Designer's Name Last
--------------
- _ First— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City _ _
State[t Zip F___7 TelephoneC
5. Engineer's Name Last
J First �— Lic. No.
Engineer's Address
Engineer's E-mail Address
City - - _ -
State F 777 Zip F___— TelephoneF77-7
❑ 6. Contractor's Name Last First Lic. No. Class
Contractor's Address
Contractor's E-mail AQ4ss
City - - 4t����
State Zip �,z Telephone
�7
OFFICE USE ONLY
PERMIT NO. Y
TYPE OF CONSTRUCTION
�I ,,•
PLAN CHECK NO.
OCCUPANCY- GROUP
TWO PLAN CHECK FEE $
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