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Associated Building Permit#
Worlistreefifor-Fire Permit Application.
City of Newport Beach - Building Division
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Fire Sprinkler F_ Fire Alarm F_ Fire Misc
AO,
S 105L
1. Project Address (Not mailing address' Floor Suite No
110s Gv(WIM F_ F_
Tenant Name # Units F
2. Description of Work
Owners E-mail Address
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Use
Extg Sq Ft New/Added Sq Ft Total Sq Ft
Valuation$ Fj , b.
Architect/Designees E-mail Address
# Stories F
F-1 New F7 Add F- Alter F_ Demo
F_ 5. Engineer's Name Last
Check Appropriate Box for ApplicantlNotification
F_ 3. Owner's Name Lasti
First F
Owner's Address
F_
Owners E-mail Address
City State I F
Telephone
zip F F
F_ 4. Architect/Designees Name Last : First F Lic. No. r
Architect/Designer's Address
F_
Architect/Designees E-mail Address
City State F
zip TelephoneF
F_ 5. Engineer's Name Last
First Lic. No.
Engineer's Address
Engineers E-mail Address
City State F
F_
Zip TelephoneF
F 6. Contractor's Name Last First Lic. No. P,,, 17 -qClass FC 71T
Contractor's Address o In
Contractor's E-mail Address
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City I State
Zip Fol IT, Telephone
OFFICE USE ONLY pel61
GZW PERMIT N:
TYPE OF CONSTRUCTION
PLAN CHECK N
OCCUPANCY - GROUP ccc I �LAN CHECK FEE $PY
1-111, '_NIV
CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT' DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658
www. newoortbeachca.aov I (949) 644-3200
SPECIAL INSPECTION REPORT
Project Address:
Permit Number: rc
Inspection Type (s):
Inspection bate (s): i9) ( ) Periodic ( ) Continuous
DEPUTY 1 INSPECTION
1-800-DEPUTYI
Gen Contr r.7 0,
Sub-Contr:
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To the best of my knowledge, the work inspected was in accordance with the Building Division approved design drawings,
specifications and applicable workmanship provisions of the U.B.C. except as noted above.
Specia Inspection Report a-24-15
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Specia Inspection Report a-24-15