HomeMy WebLinkAboutF2017-0261 - Permit Application�)Zoj�,s51f5
Worksheet for Fire Permit Application X Za16-235
City of Newport Beach - Building Division o
Please print 3 copies
Associated Building Permit # 'r„f, Fire Sprinkler F7 Fire Alarm Fire Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name # Unrts F
2. Description of Work
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f— 4. Architect/Designer's Name Last I C I,_e I I First r 6V/,_ Lic. No. r— .
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Extg Sq Ft New/Added Sq Ft `j :Total Sq Ft
Valuations LI
City
# Stories
LLL
New (`••.... Add r Alter F_Demo
Last First Lic.No. r__'.
Check Appropriate Box for Applicant/Notification
3. Owner's Name
LastI First
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Owner's Address
Owner's E-mail Address
City
_ State—: Zip Telephone�—
f— 4. Architect/Designer's Name Last I C I,_e I I First r 6V/,_ Lic. No. r— .
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City
State F_ Zip F-1 TelephonelgS I— 5 s s, 3o
F_ 5. Engineer's Name
Last First Lic.No. r__'.
Engineer's Address
Engineer's E-mail Address
City
State F-7 Zip �— Telephoned
. Contractor's Name Last �-C{—. � ` ( Y_e FirstF Lic. Nol�WWI 46 W
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V �1 �' A bl--Contrectors
Contractor's Address
E-mail Address
City
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State C�.-. Zip Telephone' I��'�J—•�"iV�J
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OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. I IR
OCCUPANCY- GROUP
PLAN CHECK FEE $
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