HomeMy WebLinkAboutF2010-0158 - Permit ApplicationPlease print 3 copies
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Worksheet for Fire Permit Application 5°
City of Newport Beach Building Department -n+`5� r- .L\e'
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1. Project Address (Not mailing address) ,, i.4 /� FI op' ,, ite
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Hoag pg. x j 99 5f-r3 3PO, 3/0,.3za,53e
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Tenant Name (if Applicable)
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# of Units (if Residential)
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2. Description of Work
Use
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If Sprinkler How Many Heads?'
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Valuation $
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# Stories
Check Appropriate Box for Applicant/Notification Information
3. Owner's Name Last'
Owner's Address
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Owners
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mail Address
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500�5 a
b 42)063
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State
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Zip I
Telephone'
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Architect/Designer's Name Last
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Architect/Designer's
E-mail Address
111
Sam-,
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City
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State
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Telephone'
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Engineer's
Engineer's Name Last
Address
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Engineer's
First
E-mail
Address
Lic. No.
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City
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State
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Zip
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Telephone)
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Contractor's Name Last)
Address
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E-mail Address
Lic. No.
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Class'
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IContractors
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y��Yctors
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City
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aAAD2,6 State
4 Zip
I 6300
Telephone'
SOS- 3 OD— ?ia9fl
OFFICE USE ONLY LI
1)�1b O1,1-}' PERMIT NO. F2-010 -0151 - g'.i WIZ
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-- 9 I Cj as -aio IO PLAN CHECK NO 05 j
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Rev 1/18/07 Associated Building Permit # I
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PLAN CHECK FEE $ (1) 1o ]G l