HomeMy WebLinkAboutF2012-0092 - Permit ApplicationPlease print 3 copies
Worksheet for Fire Permit Application
City 06.of Newport Beach - Building Department
%16120012•
Fire Sprinkler
fl Fire Alarm
ri Fire Misc
1. Project Address (Not mailing address)
tt0k6 (P'21(19 41-)
Tenant Name (if Applicable) DI 144.,4,i al th,titi
Floor
[3
# of Units (if Residential)
Suite No
[NU-
2. Description of Work
If Sprinkler How Many Heads?'
11 irclocidec
Use e,
Valuation $ I / 00-
# Stories .3
Check Appropriate Box for Applicant/Notification Information
ri 3. Owner's Name Last 1-10A-b- fiC6p—fret_
Owner's Address
I 'I. 40A-6-
ciw 13.eft_44,
State
First
Owner's E mail Address
zip I 2t, 493
Telephone'
ri 4. Architect/Designees Name Last
Architect/Designers Address
City
State
Zip
I First I
Architect/Designer's E-mail Address
Lic. No.
Telephone'
r- 5. Engineer's Name Last J j a hin
First I
Engineers Address Engineers E-mail Address
City
State
Zip
Lic. No. &Zie/13,
Telephone'
17 6. Contractor's Name Last j 4-!! pro Fitt
First I Lic. No. raW;55: Class F20---
Contractor's Address Contractor's E-mail Address
ii310 otuin foa4wk otibir
city' e44UlOkl te/A44-
State
Zip eiTal TelePh°nel gcl VP/Wee,
OFFICE USE ONLY
Rev 1/W07
Associated Building Permit # J VAL- --eV
PERMIT NO. MeT-1 -dCeS2)
PLAN CHECK NO
PLAN
PLAN CHECK FEE $